HEART ATTACK

Once stricken, a victim spent the rest of his life an emotional and physical cripple. Or, that's the way it used to be. But now, though some doctors remain skeptical, carefully planned programs of exercise offer hope of a full return to normal, active living

DOROTHY SANGSTER September 4 1965

HEART ATTACK

Once stricken, a victim spent the rest of his life an emotional and physical cripple. Or, that's the way it used to be. But now, though some doctors remain skeptical, carefully planned programs of exercise offer hope of a full return to normal, active living

DOROTHY SANGSTER September 4 1965

HEART ATTACK

A new—and surprising—way back from

Once stricken, a victim spent the rest of his life an emotional and physical cripple. Or, that's the way it used to be. But now, though some doctors remain skeptical, carefully planned programs of exercise offer hope of a full return to normal, active living

DOROTHY SANGSTER

THE NAME OF THE EXERCISE, athletic director George (Bert) Life told me, was the Incline Dumbbell Press, and the young man doing it had just completed his daily two-mile speedwalk. Now, in the gym of Toronto’s northbranch YM-YWHA, we watched him stretch out on a slanted board and lift an eighty-pound dumbbell high into the air ten times, with occasional pauses for rest. Then he got up and did some front curls with a fifty-pound dumbbell, lay on a mat for a series of energetic scissor kicks, got up again for some side bends, bar chins, push-ups and half squats, and ended with the squat thrust — vigorous double-quick changes from lying down to standing up — ten changes in fifteen seconds.

All this is somewhat incredible when you consider that only eighteen months ago Nate Leibowitz, thirty-six-year-old salesman for a fuel-supply company, had spent five weeks in bed with a heart condition.

Looking at Leibowitz today, breathing fast, but no faster than any healthy young chap after a brisk workout, Bert Life has trouble remembering that this time last year his pupil was an overweight young man with anxious eyes, who asked him nervously, “Does being a heart patient mean that my active physical life is all over?” Bert’s answer then was the same answer he’s given to each of the twenty-eight cardiac cases who exercise at the Y under his supervision: “Only if you want it that way.”

HOW DOES EXERCISE HELP?

That Leibowitz and hundreds like him in Canada, the United States and Britain aren’t crippled, physically and emotionally, by a disease that is No. 1 killer in these countries is largely due to a growing conviction among a vociferous minority of the medical profession: that exercise — graduated, progressive, and individually prescribed — is an effective method of preventing more serious inroads of the disease.

Heart disease (an overall term that generally

includes strokes, heart attacks and other diseases of the circulatory system) is responsible for half the annual deaths in this country. The great majority of male victims are men in their busy middle years, but lately, ominously, heart disease is striking earlier. A Toronto cardiologist with twenty-five years’ experience says, “You’d be surprised how many men in their early thirties come to my door these days —young men, with young wives and babies still in the cradle. It’s frightening.”

If there’s anything encouraging about the picture, it is that heart attacks today aren’t the devastating things they once were.

Dr. John B. Armstrong, executive director of the Canadian Heart Foundation, says, “Twenty years ago, if a man got a coronary he’d spend three months in a wheelchair and the rest of his life as an invalid. Today, some are out of bed on the second day, and some doctors actually claim that a heart patient can become healthier after an attack than he was before.”

Medical exponents of exercise claim that walking, jogging and calisthenics (“the right kind of exercise”) make the difference between a healthy heart patient and an unhealthy one. They believe that exercise helps postcardiac patients in two ways.

First, it strengthens the heart and the body. Everybody, sick or healthy, needs some degree of speed, strength, skill, flexibility and endurance to cope with the demands of life. If we’re not in shape, the effect of any sudden demand on our hearts may be painful, injurious, even fatal. If we are in shape, there’s hope.

Hans Selye, Canada’s famous authority on stress, has declared, “By exercising intelligently, a man can train his heart to resist attacks that might otherwise kill him.” Selye himself gets up at 5 a.m. for an hour of exercise, and the end of his workday finds him running up and down a formidable flight of stairs on the side of Montreal’s Mount Royal.

The second way that exercise is beneficial, say its proponents, is in the actual realm of disease: in conjunction with diet, it may deter, or possibly even prevent, atherosclerosis, the peculiar malady thought to cause ninety percent of all coronary attacks.

PORTRAIT OF A VICTIM

Is there a “typical cardiac victim”? Dr. Herman K. Hellerstein, a noted American cardiologist who is described by physical-fitness experts, such as Toronto’s Lloyd Percival, as “the high priest of this whole exercise thing,” says he wouldn’t rely on any specification. But other doctors note that a high percentage of heart cases are energetic, restless, ambitious males, hard-driving and aggressive, “the kind of fellow who plays golf and bets every hole, plays cards for stakes, does everything competitively, and can't relax for ten straight minutes.” If, in addition, he’s overweight, with hypertension and/or a high level of fatty substances in his blood stream; if he smokes heavily and has a family history of heart disease or gout or diabetes—then, say the exercise touters, he ought to be on the gym floor. There, according to Dr. Paul Dudley White, the cardiologist who treated President Eisenhower, exercise could help him four ways:

1. By contracting the skeletal muscles of his legs, squeezing the veins, and helping to pump blood back to his heart;

2. By helping to avoid stasis (stagnation in blood flow) in his leg veins so that blood clots don’t form;

3. By giving him muscular fatigue, “a better, safer tranquilizer than any drug on the market”;

4. By producing an active muscular metabolism which may delay, or even prevent, the formation of fatty particles in the lining of the arteries.

While Dr. White was making these claims for exercise recently at a meeting of cardiologists in Boston. / continued on page 26

WARNING: consult your doctor before exercising

“Before any middle-aged person begins a program of physical fitness or heavy exercise, he should consult his doctor to be sure his body can withstand this type of effort. This cautionary note is particularly directed to patients with heart disease, since strenuous exercise makes the heart work harder.”

Dr. John B. Armstrong, Executive Director, Canadian Heart Foundation

continued on page 26

Timidity or caution—which makes some doctors pause?

HEART ATTACK

continued front page 13

another physician, Dr. John O. Holleszy, of the United States Health Service, was gathering evidence in a University of Illinois study that exercise is safe and beneficial for even the middle-aged man who has slackened off since the physically active days of his youth. And in another recent American experiment by Doctors John Naughton and Bruno Balkc, the work capacity of men with coronaryartery disease was tested. At the end of (he experiment, the doctors noted: “None of the cardiacs experienced angina during the test or the recovery period ...”

What does all this south-of-theborder research mean to Canadian doctors and patients? Numerically speaking, not much as yet.

Exercise enthusiasts blame the Canadian lag on the medical profession, which they charge with timidity. They claim that there’s plenty of proof that exercise is safe and beneficial for heart cases, if Canadian doctors would only accept it.

In defense, most physicians insist they’ve got to be sure. Says Dr. Armstrong of the Canadian Heart Foundation, “There’s no evidence that exercise is bad. but the body of evidence showing that it’s good isn’t big enough or reliable enough yet.’

He’d like to see more research, such as a recent twelve-week study at the University of Western Ontario by a team led by Dr. P. A. Rechnitzer and M. S. Yuhasz, a PhD in physical education. Their experiment compared a group of four male volunteers with a history of heart disease with a group of four healthy men. Both groups engaged in a modified endurance test. As the weeks passed, the exercise was increased. By the ninth week the cardiacs were able to keep up with the group of normal males in a regular physical-fitness class. At the end of twelve weeks, they were performing vigorous exercises without difficulty and three of the four cardiacs could run a mile in 7.45 to eight minutes. They gained confidence when they found they could work better and enjoy active recreation without harmful results.

It's research like this —carefully assessed, in medical terms, and involving a control group—that’s meaningful to the medical profession. A leading Toronto cardiologist declares, "Until there’s more of it. the exercise enthusiasts will shout but the doctors w ill back off scared.”

When Nate Leibowitz, suffering with chest pains, finally called his doctor, his condition was diagnosed as angina pectoris (evidence of coronaryartery disease). Therapy: bed rest for five weeks, no more cigarettes, tranquilizers three times a day and digitalis for emergencies, and a newlow - fat diet. Three months later, Leibow'itz’ doctor — a lean man of fifty-two who exercises three times a week and sees no reason why a young man without any symptoms shouldn't do the same — examined him carefully. found him improved, and refer-

red him to athletic director Bert Life.

Seven months after he collapsed with angina, Leibowitz was playing badminton, but only for exercise, not in competition. (Says Life, “I’d been watching him carefully, and his doctor gave the green light, so I decided to let him play a bit. After all, he’s only thirty-seven. If he’d been older, or had any symptoms, I’d have probably turned him down — or at least made him wait longer.” (For serious heart cases, of course, such exercises as badminton, tennis, squash and handball are definitely out.)

Nate Leibow'itz, says his doctor, is vastly improved.

Max Waese, another young businessman who is following Life’s exercise program on doctor’s orders, is also much better. Waese was forty when he collapsed with a coronary attack. For eleven days he was kept in an oxygen tent and for weeks after that he lay in bed, brooding fearfully.

Because Waese’s coronary attack had been such a serious one, his physician (one of the two Toronto cardiologists who refer selected patients to Bert Life) felt it wise to make him wait six months before sending him to the Y for mild exercise. “Mild?” recalls Max, with a grin “I was too scared to lift a barbell!”

But gradually he lost his fear and today he does twenty back presses with fifty-pound barbells and thirty front curls with a thirty-pound weight. Life watches him carefully. During a summer heat spell, he noticed Waese was not quite up to par and referred him back to his cardiologist, who prescribed a few weeks’ rest, then

exercise again. Now, after a full year in the gym, Waese says, “This is doing me a world of good physically, and two worlds of good mentally.” Bert Life’s group are not the only cardiacs in Toronto who are exercising vigorously. Across the city at the Fitness Institute directed by Lloyd Percival, Canada’s most outspoken advocate of exercise for everybody, is a thirty - seven - year - old accountant named John Mondell who had a heart attack two years ago, after a week-end spent helping his son plant a tree in their garden. Weeks in an oxygen tent were followed by weeks of bed rest and a low-cholesterol diet. Then he went home, a real hypochondriac who listened to himself take every breath and woke in the night terrified of another attack. Twice in the next four months he suffered shaking spells and was sent back to the hospital, where he had more confidence just knowing doctors were around. Then he returned to work, still nervous and on tranquilizers. He kept dropping in for hospital checkups. His doctor told him, “What you need right now is a psychiatrist.” Then one Saturday morning, watching television, he turned on Sports College and there was Murray H. Robertson, executive director of the Ontario Heart Foundation, doing calisthenics. Says Mondell. “I caught the word ‘heart’ and I thought Robertson was a cardiac like me. I figured if he could do exercises, so could I. Monday morning I went down to the Heart office and they referred me to Lloyd Percival. Percival made me get my doctor’s okay, then put me through a series of tests and finally

agreed to take me on. Three months later I discovered my mistake—that fellow from the Heart Foundation wasn’t a heart case at all; he was exercising because he was overweight, tease and physically under par and he figured exercise would help him fight a possible heart attack. But by this time I was hooked.”

Exercise has given Mondell reassurance; three medical checkups have shown great improvement, both physical and mental; and he has been off tranquilizers for more than a year.

Lloyd Percival and Bert Life keep plugging away. Their aims are the same, but their programs differ somewhat in emphasis. Percival’s program is walking-jogging, weight-lifting, and general calisthenics, performed with varying degrees of intensity, interspersed with differing amounts of resting time. “For cardiacs,” he says, “I place emphasis on ‘interval work’ —moderate effort with frequent rest periods.”

Bert Life believes that for middleaged people, who are most prone to heart disease, walking is the perfect exercise. He starts his patients off with the aim of walking half a mile around the gym track. This, he says, is more of a confidence-builder than a body-builder. When a man can walk half a mile without any physical discomfort, his distance is increased gradually until he is doing two miles.

Now, says Life, the idea is to subtract a walking lap and add a jogging lap, until finally his man is jogging all but one lap. Life considers this, together with weight-lifting and calisthenics, a good “holding point” for a heart patient without symptoms of illness. He sees the doctor and himself as a two-man team, helping a cardiac patient to achieve the physical fitness that may hopefully lessen, or even avert, future trouble.

Lloyd Percival, as always, is outspoken when it comes to Canada’s needs. “What we lack,” he says, “is a careful, all-out, medically supervised exercise project like Dr. Hellerstein’s in Cleveland.”

Hellerstein, a dynamic young cardiologist who is assistant professor of medicine at Western Reserve University, is now in his eighth year of a ten-year study that began with eighteen men and has grown to six hundred and fifty. “Actually,” Hellerstein says, “we’re exercising three kinds of people: some with evident disease, some with ‘silent’ disease (one in every five cases of heart attack is silent, so the patient doesn’t even know he’s had an attack), and some with pre-morbid conditions. We don’t accept anyone who has lost so much heart muscle that his heart functions badly, or anyone with congestive heart failure, or anyone who’s obviously unable to undertake any form of exercise. Such people should not exereise v¡gorously. ’’

Hellerstein’s study is supported by funds from the U. S. Public Health Service and his approach to the problem is threefold: proper diet, a ban on smoking and step-by-step exercises to increase strength, stamina, and

heart capacity.” His nine-man team includes a psychiatrist (“much of the fatigue and depression of heart disease is psychological”), an anthropologist who measures altering body

forms and skin-fold thicknesses, and sixty-six-year-old Bill Cumber, a physical-education expert long recognized for his belief that exercise can stave off old age. Hellerstein provides his patients' wives with rulers, scales and record books. That way, he says, they feel they’re part of the team. With two years still to go, the experiment can’t be fully evaluated yet, but results are encouraging. After training. Hellerstein says, almost sixtyfive percent of those whose hearts

formerly were not getting sufficient oxygen have normalized. Cholesterol levels are down. Cleveland women are clamoring for classes and the U. S. Department of Public Health is contemplating similar projects in other American cities. Hellerstein admits that a few patients have died and some have had new heart attacks, but that was to be expected and is not significant. He says, “Our death rate is about half of what might be expected.”

In Canada, no large-scale postcoronary evaluation centre exists at present.

Says the director of the Canadian Heart Foundation, “What’s needed up here is a closer relationship between doctors and physical-training people and more meaningful research based on their mutual efforts.”

When and if such a day dawns, many more heart patients may find themselves cheerfully doing push-ups in their local gym. ★