Medical prescription: how to exercise with Valvular Heart Disease

The normal heart has four chambers and four valves. The valves are the pulmonary valve, aortic valve, tricuspid valve, and mitral valve. Valvular heart disease describes any disease or damage to any of the valves of the heart.

Individuals with valvular heart disease can still benefit from exercise. A set of physical activities can lower blood pressure, cholesterol, blood sugar levels, and help manage weight. Although exercise does not improve the function of diseased valves, it can improve the efficiency of oxygen extraction by the skeletal muscles and improve the individual's capacity for physical work.

The key to maximising the benefits of exercise is to follow a well-designed program that is safe and sustainable over the long term. That said, these are characteristics to take note of:

• The valves involved, type of abnormality (stenosis or regurgitation) and causes
• Severity of the valvular lesion based on echocardiographic and clinical features
• Presence of adverse secondary features such as left ventricular systolic dysfunction, chamber dilatation, exercise-induced pulmonary hypertension on echo, or exercise-induced hypotension or syncope
• Evidence of concurrent significant arrhythmias
• Presence of symptoms, in particular dyspnea, syncope, palpitations or angina

Examining an individual's medical history and physicality may uncover signs and symptoms. But sometimes, significant valvular diseases may not be so obvious.

As a precaution, running a transthoracic echocardiogram is useful. This test involves using ultrasound to create images of the heart.

Functional stress testing can also be used to double-check the significance of valvular diseases. An individual may use the treadmill or supine bicycle while hooked up to an echocardiography machine. Images of the heart during this phase may show clear deterioration of the valve function.

This is especially helpful when the patient’s symptoms don’t reflect what is shown on resting echocardiogram findings. (images of the heart when an individual is resting).

Individuals who suffer from severe valvular heart disease must undergo a series of tests. It helps determine the kinds of exercise to be prescribed. However, if the condition is mild without secondary effects, then it’s safe to prescribe any method of exercise.

For moderate regurgitant lesions(blood leaking from valves), light to moderate-intensity activities are generally allowed. In contrast, moderate valvular stenosis(hardening of the valve) should be limited to only light intensity.

Patients with bioprosthetic or mechanical valves should limit themselves to moderate or lower-intensity exercise training.

Patients on anticoagulation therapy (warfarin) for mechanical valves or atrial fibrillation should avoid contact sports.

Always remember to start at low intensity and shorter durations, choosing lower impact activities such as walking, cycling and water exercises.

Continuous evaluation of the individual is required. Over time, the condition of the valve may change which should reflect on the exercise prescribed.