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Exercise as Prevention and Treatment of Heart Disease


The exceptional economic growth and continuous modernisation of Asia, Hong Kong included, has brought about increasing risk factors and incidence of coronary heart disease (CHD). (1) In 2015, heart diseases accounted for the third most common cause of death in Hong Kong with CHD being the largest contributor to the statistics at 66.6% of all heart diseases deaths. (2) The term “Heart Disease” comprise a wide range of diseases that affect the heart while “Coronary Heart Disease” refers to the disease of the coronary arteries that supply the heart. This occurs when the coronary arteries that supply oxygen to the heart narrows due to cholesterol deposits in the inner walls, affecting the oxygen flow to the cardiac muscle leading to arm and chest pain or in severe cases, a heart attack. (2,3)


Non-communicable diseases (NCD) include heart disease, diabetes, cancer and chronic respiratory disease, is a global burden to the human population according to WHO, making up 70% of all global deaths and 55% of all registered deaths in Hong Kong. Given a health-positive physical and social environment, a third of these cases can be prevented through lifestyle choices. The primary lifestyle choice that we will focus on in this article, is physical inactivity, which also remains a public health issue. (4) Physical inactivity is a primary factor for ischemic heart disease (30%) and is a risk factor for heart diseases (4,5)


According to Japan’s Exercise and Physical Activity Guide for Health Promotion in 2006, physical activity, as a general term, is described as bodily movements that require a higher level of energy expenditure than the resting energy expenditure. They categorised physical activity to “Exercise” and “Non-Exercise Activity” (NEA). Exercise is a purposeful physical activity that is done repetitively to maintain one’s physical fitness such as jogging, swimming and cycling. NEA, on the other hand are physical activities that are not regarded as physical activity such as playing with children, walking to work and gardening. This also includes occupations that require you to be physically active such as tour guides, teachers and surgeons . (6)


The recommendation by the World Health Organisation (WHO) states that adults aged 18 or above should perform at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity or an equivalent combination of moderate and vigorous-intensity aerobic activity per week. Exercise should be performed at least 30 minutes a day, on most days and it can be divided into bouts of at least 10 minutes each time, 3 times per day. (9) The intensity of the physical activity can be measured by METs, which are units of metabolism. For example, at rest, a person will spend 1 METs of energy to maintain normal body functions. (8)

Please refer to the compendium of physical activity by Ainsworth and colleagues for a wide range of physical activities and their METs reference value. *


Based on scientific research, there is strong evidence that shows a dose-response relationship with the frequency, intensity, duration and volume of physical activity and risk of cardiovascular disease. To lower cardiovascular risk significantly, the evidence suggests that at least 150 minutes per week of moderate to vigorous intensity physical activity is required.. (9) Furthermore, dynamic aerobic endurance training evidently lowered blood pressure in certain hypertensive groups with a reduction of 8 to 10 mm Hg in both systolic and diastolic blood pressure readings. (11) All-cause mortality, meaning the death rate from all causes of death, including heart disease mortality also seems to be lower for those who are physically active. The recommendations on physical exercise training by Canadian Medical Association Journal supports this evidence by giving a grade A recommendation for those who do not have hypertension but have established atherosclerotic disease to become physically active to reduce the risk of cardiovascular disease mortality, re-infarction and from other causes. (8)


Here are some general guidelines to start exercising when you have heart disease. It is best to speak to your healthcare provider before you start any exercise program. The general recommendation is to start slow and choose a low-impact aerobic exercise such as swimming, jogging or cycling at least 3-4 times each week. It is recommended that the exercise training program into 3 periods: warm up, training and cool down, a proper warm up and cool down (at least 5 minutes of light intensity) can have a protective effect on the heart. People with heart disease should be more aware of the weather when exercising outdoors, whether it is too cold or too hot and dress accordingly. Hydration is an important factor as well, it is advisable to always carry a water bottle to rehydrate when necessary. Resistance training and weight training are also recommended to improve the musculoskeletal system, providing overall health benefits. The key is to start slow with minimal repetition. As with all exercises, It is essential to listen to one's body and take sufficient rest time whenever necessary. Medical attention should be sought when these alarm signs are present; worsening of heart disease, numbing, shortness of breath and lightheadedness. (12,13)


Given extensive evidence on the benefits of exercise, there are remaining safety concerns regarding exercise for this population and the risk of a cardiovascular event during exercise. Studies have shown that, compared to otherwise healthy individuals, the risk is higher for those with heart diseases. However, the absolute incidence of death during exercise is relatively low. Musculoskeletal injuries, on the other hand, are common, as with repetitive exercises. (7,8) As a general note, a medical evaluation by the individual’s physician and exercise professional, and pre-participation screening should be performed adequately by trained exercise professionals to identify problem areas and high-risk individuals. In addition, the training and preparedness of exercise professionals in emergencies are essential and must meet industry standards. In conclusion, the overall health benefits of exercise outweigh the potential risk of exercise, which can be reduced significantly through pre-participation screening, medical evaluation and through the guidance of a trained exercise professional. (7)



Image Reference: (13) Recommendations for Prescribing Exercise to Patients with Heart Disease 8 8 Recommendations for Prescribing Exercise to 8 Patients with Heart Disease. (n.d.). [online] Available at: https://www.chp.gov.hk/archive/epp/files/DoctorsHanbook_ch8.pdf.


REFERENCE: (1) Janus, E.D., Postiglione, A., Singh, R.B. and Lewis, B. (1996). The Modernization of Asia. Circulation, 94(11), pp.2671–2673.

(2).Chp.gov.hk. (2019). Centre for Health Protection, Department of Health - Heart Diseases. [online] Available at: https://www.chp.gov.hk/en/healthtopics/content/25/57.html.

(3)Endler, N.S. (2001). Coronary Heart Disease (CHD), Coping with. [online] ScienceDirect. Available at: https://www.sciencedirect.com/science/article/pii/B0080430767038110 [Accessed 19 Aug. 2020].

(4) TOWARDS 2025 Strategy and Action Plan to Prevent and Control Non-communicable Diseases in Hong Kong Summary Report. (n.d.). [online] Available at: https://www.chp.gov.hk/files/pdf/saptowards2025_summaryreport_en.pdf [Accessed 19 Aug. 2020].

(5)HONG, YULING & Bots, Michiel & PAN, XINWEI & WANG, HUIZHEN & JING, HUAIGEN & Hofman, Albert & CHEN, HAOZHU. (1994). Physical Activity and Cardiovascular Risk Factors in Rural Shanghai, China. International Journal of Epidemiology. 23. 10.1093/ije/23.6.1154.

(6) Exercise and Physical Activity Guide for Health Promotion 2006. (2006). [online] Available at: https://www.nibiohn.go.jp/files/exercise_guide.pdf [Accessed 19 Aug. 2020].

(7)Balady, G.J., Chaitman, B., Driscoll, D., Foster, C., Froelicher, E., Gordon, N., Pate, R., Rippe, J. and Bazzarre, T. (1998). Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities. Circulation, 97(22), pp.2283–2293.

(8)Cleroux, J., Feldman, R. and Petrella, R. (1999). Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ: Canadian Medical Association Journal, [online] 160(9), pp.S21–S28. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1230336/.

(9) Information, N.C. for B., Pike, U.S.N.L. of M. 8600 R., MD, B. and Usa, 20894 (2010). EXECUTIVE SUMMARY. [online] www.ncbi.nlm.nih.gov. World Health Organization. Available at: https://www.ncbi.nlm.nih.gov/books/NBK305060/#ch1.s1 [Accessed 19 Aug. 2020].

(10) Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46(4):667-675. doi:10.1161/01.HYP.0000184225.05629.51

(11) Fletcher, G.F., Balady, G., Blair, S.N., Blumenthal, J., Caspersen, C., Chaitman, B., Epstein, S., Froelicher, E.S.S., Froelicher, V.F., Pina, I.L. and Pollock, M.L. (1996). Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans. Circulation, 94(4), pp.857–862.

(12) Medlineplus.gov. (2014). Being active when you have heart disease: MedlinePlus Medical Encyclopedia. [online] Available at: https://medlineplus.gov/ency/patientinstructions/000094.htm.

(13) Recommendations for Prescribing Exercise to Patients with Heart Disease 8 8 Recommendations for Prescribing Exercise to 8 Patients with Heart Disease. (n.d.). [online] Available at: https://www.chp.gov.hk/archive/epp/files/DoctorsHanbook_ch8.pdf.







What is mind-muscle connection? [Part 2]

Previously, we talked about what and how to be connected with our own muscle through exercise and now, we are going to dive deeper into understanding the benefits of mastering muscle mind connection.

Micro management of muscle growth

Each movement of the human body is initiated from the brain through a

series of chemicals that are released through your spinal cord to the nerves that control the muscles. With the constant practice of mind muscle connection, your muscle sensitivity will increase, allowing you to be more aware of your movements including the smallest muscle twitch. When we are able to focus on the part of muscle we want to work on and perform an isolated exercise, we will avoid the use of other major muscle groups. 

Evaluate your own body condition or injury

To be connected with your muscle, is like fine tuning your musical instrument before your concert. You will know which part of your body is "out of tune". Generally, Your body will send out signals to reflect the current condition. This will come in handy when you need to make the decision for "stop or carry on” during your workout. You can feel even the slightest discomfort or could evaluate if your injury is minor or serious. This is essential for every workout performance as people often overlook their minor injuries that could potentially lead to serious injuries or conditions later on. As it is often emphasized, “resting is a part of your training”, mind muscle connection allows you to know and understand when to rest and when to put your training on hold and consider a visit of your physician. 

Prevent Injuries Significantly

Injury —> Rest —> Rehab —> Recovery —> Injury

For those who has been working out for a while now, we have been through this cycle once or twice before and for some, it is an endless cycle if we do not change the way we work out. The length of recovery depends on several factors including the severity of the injury, the recovery rate of the patient and the rehabilitation process. Most of the training accidents happened within the first three months of your training, either through improper use of equipments/exercise form/posture and some injuries can become permanent if we are not careful. These accidents can reduce greatly through practicing mind muscle connection. As detailed in part 1 of our mind-muscle connection article, this means focusing on the prime mover muscle, staying in the proper form/ posture, being able to sense muscle fatigue and avoiding over-training. 

Ability to Manipulate movement

In order to get the full benefit of the exercise, we need to understand to use the right muscle. As we build a good connection with our muscle, we can start manipulating our exercise/movement like, "speed", "range of motion", "peak contraction"...etc. We learnt that most of the movement/exercise can be executed in many different ways and it all depends on the result that we are trying to achieve. This will allow us to have stronger stimulation for our muscle, thus enhance the muscle overall growth. 

Now you understand the benefits of mind-muscle connection, you can start implementing this into your regular workout regime today! Speak to any of our Qintensity coaches today if you have any questions in this area!



What is mind-muscle connection?


When you’re doing an intense HIIT session or in the middle of a hatha yoga class and your trainer says “Focus on the mind-muscle connection," what does he mean, exactly? We will break it down to you in this article today!

Have you ever thought about which muscle groups you are working on when you are performing an exercise? Let’s say, a simple pull-up exercise. When you’re pulling yourself up the bar, you’re mainly working on the back area and that is the muscle you should be working, that is the primary muscle group. At the same time, we are also using our biceps to help stabilise our body and that is our secondary muscle group. A frequent complaint after a few repetitions is that our arms are tired instead of feeling it in our back. This is the moment where “mind-muscle connection” comes in, we can control our minds to tell our body to execute the movement by using our back muscles instead of relying on our biceps.


How do we do it?

Start light, go slow and steady and focus on the form.


Starting out light


When we start doing a new exercise, our bodies will make intelligent adjustments to help us complete the exercise in the most efficient way without using too much energy. However, this may not be the correct way. To ensure the perfect form and proper use of all muscle groups, we have to start out with lighter weights. This will prevent us from using the secondary muscle group. 


Go slow and steady


Rather than rushing off to finish an exercise repetition, go slow and steady and feel the slow burn from inside. When you go slow, you become more mindful of the burning sensation coming from the muscles. This sensation will help us understand how and which part of muscles we are working on. 


Form-focused


This is the ground rule for any exercise, you have to ensure that your form is correct to avoid any injuries and to get the most benefit out of your workout. If you’re unsure if your form is correct when you’re performing an exercise, check with your trainer! They are always there to help!


Understanding which muscle group should be feeling the burn at each exercise is crucial for any workout program. Simply put, if you don't know which group of muscle you need to use to perform the exercise, then how could you make the right connection with your muscle?


Next month, we will dwelve into the benefits of mind-muscle connection. One of them being, spending half the time on exercise but achieving double the result! Sounds incredible? Stay tuned to our next article!