Dr James Le Fanu: 21 February
Exercise, as all know, increases the muscles’ demand for oxygen which, if it cannot be met because the arteries to the heart or leg are narrowed, results in two distinct types of pain – known respectively as angina and claudication – of such intensity there is no alternative other than to desist. Those with either condition must, by necessity, learn to pace themselves – though paradoxically, exercising regularly through the pain often results in a marked improvement. Thus, the first account of angina, by the English physician William Heberden, and published in 1772, describes the case of a man who ‘set himself the task of sawing wood for half an hour every day – and was nearly cured’.
This improvement is attributed to two important physiological adaptations – slowing of the heart rate and fall in blood pressure – that together reduce the heart muscles’ need for oxygen. Regrettably, though, this prescription of ‘exercise’ for those with angina is not without its hazards, as heavy exertion (such as sawing wood) can increase the risk of heart attack, even among the fit.
The same dilemma does not arise in those whose mobility is restricted by the vice-like calf pain of claudication. This too improves, often dramatically, with regular exercise as demonstrated by the Danish physiologist, Andre Larssen, who instructed a group of patients to spend one hour per day walking for as long as their pain would permit, to rest until it disappeared, then walk again as energetically as possible. After six months, their average walking distance had increased 300% and the time elapsing before the onset of the claudication pain had increased threefold.
The most plausible explanation would be that this exercise regime opens up the smaller arteries to the leg, increasing the network of capillaries in the muscles and improving the e ciency with which the oxygen is delivered. The further recommendation of stopping smoking also works at this level of microcirculation and those who quit are rewarded by an almost immediate improvement in the amount of exercise they can take. Thus the advice for those with claudication can be encapsulated in the veword axiom: ‘Stop smoking and keep walking!’ Advice that will provide measurable improvement in virtually all.
This week’s medical query comes courtesy of a lady from Yorkshire writing on behalf of her husband. They both enjoy cruises but on the last few occasions, he has been troubled at the end of the day by marked swelling of the legs – though the next morning ‘they are their normal, skinny selves again’. Their family doctor has only suggested they stop going on cruises, which obviously they are reluctant to do.
This well-recognised problem is often attributed to the allegedly high salt content of the meals served on cruise ships. It is more probable, however, that this is likely to be a gravitational effect, where for reasons that are not well understood, the buoyancy of the sea reduces the pressure, returning blood from the legs back up to the heart. The only remedy is to take diuretic or water tablets, such as frusemide.
Email drjames@lady.co.uk
This improvement is attributed to two important physiological adaptations – slowing of the heart rate and fall in blood pressure – that together reduce the heart muscles’ need for oxygen. Regrettably, though, this prescription of ‘exercise’ for those with angina is not without its hazards, as heavy exertion (such as sawing wood) can increase the risk of heart attack, even among the fit.
The same dilemma does not arise in those whose mobility is restricted by the vice-like calf pain of claudication. This too improves, often dramatically, with regular exercise as demonstrated by the Danish physiologist, Andre Larssen, who instructed a group of patients to spend one hour per day walking for as long as their pain would permit, to rest until it disappeared, then walk again as energetically as possible. After six months, their average walking distance had increased 300% and the time elapsing before the onset of the claudication pain had increased threefold.
The most plausible explanation would be that this exercise regime opens up the smaller arteries to the leg, increasing the network of capillaries in the muscles and improving the e ciency with which the oxygen is delivered. The further recommendation of stopping smoking also works at this level of microcirculation and those who quit are rewarded by an almost immediate improvement in the amount of exercise they can take. Thus the advice for those with claudication can be encapsulated in the veword axiom: ‘Stop smoking and keep walking!’ Advice that will provide measurable improvement in virtually all.
This week’s medical query comes courtesy of a lady from Yorkshire writing on behalf of her husband. They both enjoy cruises but on the last few occasions, he has been troubled at the end of the day by marked swelling of the legs – though the next morning ‘they are their normal, skinny selves again’. Their family doctor has only suggested they stop going on cruises, which obviously they are reluctant to do.
This well-recognised problem is often attributed to the allegedly high salt content of the meals served on cruise ships. It is more probable, however, that this is likely to be a gravitational effect, where for reasons that are not well understood, the buoyancy of the sea reduces the pressure, returning blood from the legs back up to the heart. The only remedy is to take diuretic or water tablets, such as frusemide.
Email drjames@lady.co.uk