Scott Webb (Host): Heart disease is common, and Summa Health is positioned to both help patients to prevent heart disease and recover from heart attacks and more. I'm joined today by Danielle Greiner, she's a clinical exercise physiologist, and Bianca Grover, she's an orthopedic exercise specialist, and they're both with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

So, it's nice to have you both here today. We're going to talk about cardiovascular health, essentially. And as I was mentioning to you before we got rolling here, you know, some of the things we do are kind of seasonal, but there's never a bad time to talk about cardiovascular health. It's always a good thing to talk about.

So, let's do that. Danielle, I'll start with you. Can you just talk about the basics of cardiovascular health? Like, what are the essentials we need to know?

Danielle Greiner: So, I think the first step is probably defining what the cardiovascular system even is. Essentially, it's our heart and all of the blood vessels, which are pathways that carry blood, oxygen, nutrients, all kinds of good stuff throughout our bodies. At the center of that, the heart is basically just a big pump, and that pump never gets a break. It is constantly moving blood throughout our body 24/7.

I looked up some fun facts, you know, just to really put into perspective how much work the heart does. And it pumps about 100,000 times a day and about 35 million times over an average lifespan. So, that is pretty tremendous that we rely on that every single day to deliver everything to our muscles, bones, and all the parts of our body that need oxygen, nutrients, and blood.

With that being said, it's really important to keep that heart healthy. Because it's a pump and a muscle, the stronger the muscle is, the better off you'll be. So, cardiovascular health refers to all the things that we can do day to day to keep the heart muscle pumping efficiently, keep it strong, and this could include things like having an exercise routine, choosing good dietary patterns, controlling your blood pressure, managing your stress, not smoking; if you're diabetic, having good blood sugar control, among a couple other things. So, it really touches on all areas of our lifestyle to try to keep the heart healthy.

Host: Yeah. I'm still trying to process a hundred thousand times a day. It's hard to get my mind around that. So, I'm going to take some time while you're answering to continue to think about that, but I will be listening as listeners will, of course. Wondering, Danielle, what are some of the common then heart conditions that you see in patients?

Danielle Greiner: So because I work with the clinical population in my day-to-day job, unfortunately, I see patients once things have already kind of gone wrong with the heart in some way. Since that heart is basically a pump or a muscle, I like to use some analogies to help people understand the various things that can go wrong with the heart. So, we can see, first of all, things like a plumbing issue. We have certain blood vessels and arteries that go throughout our body and that feed the heart itself with blood. And those blood vessels can get clogged with plaque through a process called atherosclerosis. And that is what we refer to as heart disease. Basically, the plumbing issue is that the blood is not flowing as openly through those blood vessels as it should be. We might also see some electrical issues, and these would be called arrhythmias or problems with the electrical signals that flow through the heart. So with a normal patient, we have an electrical circuit that kind of runs around the inside of the heart like a little racetrack, and it tells the heart when to beat, how fast to beat, and it helps everything coordinate properly.

When things go wrong with that, we might see the heart beating too fast, too slow, Irregularly, or not beating at all, which you absolutely do not want to see. So, that kind of falls under the electrical issues. And there are specialized cardiologists called electrophysiologists who specialize in those electrical issues.

And lastly, we might just have some plain old structural problems with the heart itself. So, disease of the heart muscle, which sometimes we call heart failure, or that heart muscle is weakened, or maybe it's become too stiff and thickened and it doesn't pump properly, or there are certain valves within the heart that allow blood to pass through from different areas of the heart. And those valves can become diseased. They can become too stiff or maybe too floppy and they're not allowing blood to pass through properly. So, we see a wide variety of different heart issues. There are some risk factors for these issues, but heart disease really does not discriminate. So, anybody and everybody can possibly be at risk of having an issue with the heart.

Host: Right. I'm sure it's some family history, genetics, smoking, high blood pressure, sort of the greatest hits, if you will, right?

Danielle Greiner: Yeah, absolutely. And some of those things you mentioned are things that we can change and modify within our day-to-day life, other things we can't, so specifically, age, genetics, or family history in a first-degree relative, so if parents or siblings have had an issue with their heart as well as some ethnicity factors, those all are risk factors that are considered non-modifiable. We can't change them. They're good to be aware of. But there's no sense in losing sleep over them because we cannot modify those through our lifestyle, unfortunately.

Now, there are a lot of good modifiable risk factors that we can control, and those are some that you already had mentioned, like your smoking. So, not smoking, obviously, is good for the heart; controlling blood pressure, blood sugar, cholesterol, or lipid values in the blood; having an exercise routine; having a healthy diet pattern, and managing your stress.

Host: Yeah. And we think about the modifiable, the things that we should think about, we can think about, things that we can control. Bianca, what are some of the lifestyle changes that we can make to improve our cardiovascular health?

Bianca Grover: Like Danielle mentioned, we need to make sure we add a little bit more physical activity throughout our day. And I would even recommend just being active outside of a planned workout. So, try and park your car a little further away from the building, take some extra steps. Move around the house, clean up the house, do some dishes. Movement is medicine. So, that's always the first thing I always recommend to people working at a wellness center. We always see people trying to be more active. So, there are many ways to do that outside of a planned lifting routine or a cardio routine. Diet is a huge one. Mainly, we want to add more fruits and veggies to our diets, focus on getting the healthy fats, and prioritizing whole grain in our diets. Believe it or not, sleep can affect cardiovascular health as well. So, it's always recommended to try and get at least 7 to 8 hours of quality sleep. It's good for the heart and manage stress. Try and practice mindfulness, meditation, take some time to yourself and just kind of try to deal with the stress that comes through the day.

Host: Yeah. Love what you said there. Movement is medicine. So, how does nutrition and diet affect our heart health? And can you maybe give us some suggestions and tips for a better nutrition plan? I've heard things about the Mediterranean diet. I've heard things like when you go to the grocery store, stay around the outside. All the processed things are on the inside of the grocery store, so stay around the outside, but wondering what suggestions you have.

Bianca Grover: Mediterranean diet, that's probably the best route you can go for heart health, because it focuses on getting those healthy fats in, like the omega-3s, limiting saturated fats, and avoiding trans fats as much as it's possible. So, limiting that red meat, adding more fruits and veggies to the diet. Other than that, we do need to remember that the quality and content of the diet can affect our blood pressure and the inflammation levels in our body, which chronic inflammation is linked to the pathogenesis of coronary artery disease. So, diet is definitely not something we should sleep on. Those are mainly the ones I was thinking of. Danielle, do you have anything you would add? Anything you educate people in in cardiac rehab?

Danielle Greiner: The amount of information out there about diet, what you should and shouldn't be doing, what eating patterns you should follow, I find that it's very overwhelming for not only myself, even working in this field, but especially for patients who are of varying, you know, educational levels, varying socioeconomic backgrounds. And so, my best recommendation, if you're looking into trying to find reliable and very reasonable diet and nutrition information, I would probably recommend that people check out the American Heart Association website. It's heart.org, and they offer some amazing resources for just very basic recipes, how to grocery shop, budgeting tips for how to eat healthy if you have a limited budget, and they also have resources in various languages, which is nice as well.

So, I had a Spanish patient a couple of weeks ago, and he was trying to learn how to eat a heart-healthy diet, and I was able to print off some resources for him in Spanish. So, definitely some good resources on the website, heart.org. And you can also look at the USDA website, which is a government website, but they give us some good resources as well. Anything that promises quick results or mentions extreme restriction of certain foods or nutrients is most likely a fad diet and is not something that I would typically recommend. If it's too good to be true, it probably is not a valid or safe dietary habit to form.

Host: Yeah. It does seem that the focus of a lot of these things is about calories and weight loss and not necessarily about heart health. So as you say, there's some good resources there specifically, you know, some recipes and things to promote better heart health. And wondering, Bianca, when we think about heart health and exercise, you mentioned movement, that type of thing, do you have any suggestions for people who want to actually begin an exercise program?

Bianca Grover: Before starting anything, even if you're new to exercise, I would get the physician's consent. They might know things that you're not aware of. They might give you some good pointers and guidelines you should be following. Second thing, I might be a little biased saying this, but do consider working with a professional in the beginning, even if it's just for a few sessions or for a couple of weeks to get the form down. Form is always more important than the weight you move, so professionals are here to help. Talking about nutrition again, think of nutrition as fuel for performance rather than a reward or punishment. So, you should be eating enough, and you should be eating clean. So, do pay attention to the content of your diet, like we just talked about. Don't try and eliminate macronutrients. Everything is there for a reason. Carbs are important. Protein is important. Fats are important. So if you want more information on that, consider working with a registered dietitian.

Wear comfortable clothing, proper shoes for the type of physical activity you'll be engaging in. So, let's say if we want to do some weightlifting, wear the proper shoes. Maybe running shoes are not the best types of shoes to do lunges and squats in. Prioritize both strength training and cardio. They are both important for different reasons. Cardio, for obvious reasons that we're talking about right now, can improve the efficiency of your heart, the health of your heart, but strength is also important for bone density, for strength in general, functional levels, and just overall an improved quality of life. Make sure you stretch. Focus on mobility, a mobile body is a strong body. And hydrate, hydration is very important. Replace the water you use during physical activity. I think for women, it is recommended around nine cups a day and for men around 13 cups a day. Now, of course, that can change based on the individual, fitness level, age, size and all of that.

And probably most importantly in the beginning especially, ease into things and be kind to yourself. If you're a beginner, some things might look a little overwhelming, but it's okay. Everybody belongs in the gym and everybody is welcome to try something new that's going to improve their life.

Host: Right. Yeah, if you haven't been exercising or it's been a long time, don't just head out the front door and run a 5K or something, right? Work your way up to things like that. I'm sure you would agree, Danielle, that some moderation early on is probably good for most folks.

Danielle Greiner: Definitely. I would echo what Bianca said. Start small. And what we consider to be aerobic exercise or cardio is just anything that's going to get the heart rate up and keep it up for a period of time. So, that may not look like going to a gym for some people. That is a wonderful option though, and I always recommend having access to exercise equipment. But maybe for some other people, that looks like getting a workout video that you really like from the library. Maybe going for a walk with the neighbor, doing some gardening or push mowing throughout the day. So, we look for a little bit more structure with exercise. We do want you to go out there with the intention of increasing the heart rate, but there's a lot of different ways that you can achieve that.

It also helps to have a workout partner. A lot of people when they're trying to initiate a new behavior need someone to hold them accountable. So if they have someone in their life that wants to also either initiate exercise or that is a routine exerciser, that can be really motivating for people. So if you do want to go to a facility, check out your local gyms, wellness centers, YMCAs. Also, check into insurance coverage, especially individuals who are on Medicare or certain other insurances likely will have coverage through Silver Sneakers, which is a adult wellness program that usually waives fees for all fitness facilities. And there's a lot of participating facilities, so that's a great option.

Host: Yeah, definitely. And maybe the million-dollar question, Danielle, is because you said you often see folks when things have already gone wrong, unfortunately. So, we think about prevention maybe. But either way, when do we see a doctor about our hearts? Should we always try to prevent the things before they happen? Or maybe what are some of the signs and symptoms? But just from your experience and your expertise, when do we reach out?

Danielle Greiner: Ideally, primary prevention is key, meaning if you know that you have a strong family history of heart disease, it's always a good idea to establish with a cardiologist before you start having signs or symptoms that might be suggestive of heart disease for yourself. You want to make sure that you're taking the proper precautions, and they're doing proper screenings to make sure you don't head down that path if you are genetically predisposed to heart problems.

Now, your family doctor or PCP can also do some basic screenings, so it's really important to follow up with a doctor in general, even if it is just a PCP. They can always refer you out to a specialist if they think that there might be some more concerns based on the preventive screenings that they do.

Now, beyond that, let's say you're already having some questionable signs or symptoms and you're not sure if it's something going on with the heart or if it's something you don't need to worry about, one of the most common and earliest signs of heart problems is chest pain. And pain doesn't always mean, "Ouch, that hurts in my chest." It might be a pressure, it might be heaviness, tightness, squeezing. It may radiate out from the center of the chest. It may go to your shoulders, your neck, your back, your arms, one or both arms. And then, everyone is going to experience that a little bit differently if they do. So, my biggest piece of advice is do not ignore any signs or symptoms, like all caps emphasizing do not ignore any signs or symptoms that might be suggestive of heart disease. So, know that chest pain doesn't always feel like pain. It might present a little bit differently. We do find that in individuals who are female or individuals with diabetes, they tend to present differently than patients who are male or non-diabetic, meaning they don't experience the typical chest pain symptoms that we might see, like in movies or TV, so just keep that in mind.

And this can also happen, especially when you're up and moving around, so we call chest pain, in medical terms, angina. And there can be something called exertional angina, meaning every time you get up and move around or exert yourself, you feel that pain. And that's a warning sign that the amount of blood flow that the body is asking for at that point in time, the heart is not able to keep up with that demand. So, that's a really, really early sign that something could be going on with the heart. You might also notice things like dizziness, lightheadedness, unexplained passing out, heart racing, or heart fluttering sensations. Anything that feels abnormal in the chest is a good indication that you want to look into that a little bit more. You don't want to wait around to see if it gets worse. You don't want to try to say, "Oh, I'm just out of shape or deconditioned. I'm just getting older." Those are not normal signs of aging. That's something that definitely needs to be looked into further.

Host: Yeah, I know they say that time is brain when it comes to stroke and, you know, time is heart. So, as you say, any signs and symptoms, anything that seems out of the ordinary, that's a great time to reach out to your doctor and/or maybe head right to the ED, depending, of course. So Danielle, let's talk about cardiopulmonary rehab. That's your thing. So, take us through that. How does a patient end up there? What are typical visits like and so on?

Danielle Greiner: Sure. So, cardiopulmonary rehabilitation, we just shorten it as cardiac rehab oftentimes, but it's an exercise and education program for patients who have heart disease. So, we see a wide variety of patients, but everyone is either recovering from or trying to manage some kind of issue with the heart, whether it was a plumbing issue, a mechanical issue, an electrical issue, et cetera. We see patients oftentimes after certain heart surgeries. And we also see them after things like heart attacks or certain procedures to open up the blood vessels in the heart. So, this is a form of secondary prevention, meaning, unfortunately, we can't take back what's already happened, but we can minimize the impact of the heart disease on that patient's life. So, we're trying to do that through lifestyle. That would be mainly exercise, so patients come in a couple days per week for about one hour and they do different exercises that are aimed at strengthening the heart and helping that heart recover from whatever it just went through.

Usually, this is something that started a couple weeks after a hospitalization. So, these patients, you can imagine, you know, if you or a loved one has ever gone through something like this, you're kind of scared. You're, not really sure how much your body's able to do post-heart attack, let's say, and you're apprehensive to resume exercise. Maybe you want a little bit more supervision, and that's exactly what this program is. So, it's a clinically and medically supervised program. We have a medical director who oversees our patients, and then day to day on the floor, we have departmental staff who are monitoring the patient's response to exercise.

Host: Yeah, I think the supervision part is the thing for me. I haven't been through this-- knock on fake wood here at my desk. But I feel like to your point that once people have had, folks have had some sort of cardiac event or issue or whatever it might have been, that there would be that fear of exercising and doing things that get your heart rate up. And I'm sure that's a big part of what you deal with is getting them over that, right?

Danielle Greiner: Right, absolutely. And sometimes we see the opposite end of the spectrum where patients maybe were previous exercisers and they're so eager to get back to a running schedule or a lifting schedule that they just want to go zero to 100%. So, sometimes I have to do a bit of scaling back for patients. Other times, I have to do a bit of pushing patients. But it just goes to show everybody experiences this differently, and we try to meet those patients where they're at and make sure that, one, they can exercise comfortably without signs or symptoms of any heart disease. And two, they have a good solid plan for continued exercise once they're done with their time here in cardiopulmonary rehab.

Host: Right. They kind of learn from you, get the basics, maybe get pushed, maybe get held back a little bit, whatever it is. But then, they can continue on with that program once they're back home full time and they're really back on their feet and doing things again, right?

Danielle Greiner: Yep, exactly.

Host: Yeah, that's great. Bianca, I want to have you talk about the Summa Health Wellness Center and how it helps patients. I've talked to some other folks about this and I know that it is really beneficial, lots of benefits. So, take listeners through some of them.

Bianca Grover: Yeah, absolutely. So, we are a medically based facility, which means the people staffing the fitness section of the building all have a four-year degree in exercise physiology. So, we are prepared to take care of people with special considerations like orthopedic considerations, cardiovascular considerations. We even work with people in a neuro exercise program which kind of helps with Parkinson's, dementia, just kind of helps people maintain that functionality and strength as they're dealing with their current situations. We also have an ortho program that's usually used as a post-rehab program for people who just finish physical therapy or occupational therapy and should continue to be active, but would like a little bit of extra guidance. So, that's available for people.

We also offer body composition scans, VO2 max tests, and resting metabolic rate tests. So, people kind of get a baseline reading on their cardiovascular status and metabolic status and that can pertain to a variety of goals. So, we help people when they try to start a weight loss journey. We help them improve their cardiovascular fitness by doing that VO2 max at first and getting a baseline. So, we have a variety of services here. On top of that, we have a fully equipped strength floor, we have free weights, machines. We have a basketball court, we have swimming pools. I always like to tell people we have a little bit of everything, including group exercise too, tai chi, yoga, mobility classes.

So on top of the things I mentioned, we also offer coaching services, including nutrition services and also the sleep stress management and recovery coaching. And that one is geared more for performance oriented people who are trying to get a hang of their sleep schedules, how to handle stress throughout their lives and recover for athletic events they're trying to engage in.

Host: Yeah. Good stuff. I just want to give you a chance here at the end. I'll start with you, Danielle. Just final thoughts, takeaways, whether it's about Summa health or the work that you do, you know, when it comes to the cardiopulmonary rehab, just cardiovascular health in general. Let's just kind of put a period at the end of the sentence for folks.

Danielle Greiner: Sure. I'd like to give a quick shout out to the Summa Health cardiovascular team. We have a wonderful group of heart doctors here in various subspecialties of Cardiology as well. Surgery, electrophysiology, structural heart disease, et cetera, et cetera. It seems like they keep adding more and more to the team like every month, which is amazing and exciting. And one of the biggest determinants of a patient's participation in cardiac rehab is the strength of the provider's endorsement of our program. So basically, that means that the more the provider says, yes, you should do this program, it's going to help you, you're going to feel so much better when you're done, the more likely the patient is to participate. So, I feel confident knowing that our providers are really knowledgeable about our program. They can endorse that program and they can keep sending patients our way.

Unfortunately, heart disease is not going away anytime soon. It's still something that we're going to be dealing with probably more and more as the decades progress. So, this is something that we are well equipped to handle at Summa and I feel very good and fulfilled to be a part of this effort to understand that, yes, there is a time and a place for medications and doctor's visits and compliance with that procedure, surgeries, et cetera. But there is a lot you can do with something as simple as exercise and other lifestyle choices to reduce the chance of having to deal with heart disease now or down the road.

Host: Right. That's perfect. Bianca, final thoughts?

Bianca Grover: Prevention is always better than treatment. It's always cheaper than treatment. So definitely, pay attention to those lifestyle choices, prioritize physical activity, and prioritize a mindful diet. Exercise can be enjoyable. I know exercise is not always fun, but it does feel good. And it does feel like a big accomplishment once you're done and you see the benefits from it.

Host: Yeah, definitely. Well, I really appreciate your time today. Just nice to learn more about cardiopulmonary rehab and the Summa Health Wellness Center, all the comprehensive services and the doctors and everybody doing their work there trying to prevent, but also help after the fact. So, really good stuff. Thank you both.

Danielle Greiner: Thank you so much.

Bianca Grover: Thank you for having us.

Host: And to learn more about our services, visit summahealth.org/cardiac-rehab or visit summahealth.org/wellness-center. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.