I see lots of THROB members coming to exercise class clutching bottles in their hands, as indeed I do, and I long to know what all these bottles contain. Gin and orange?...Vodka and tonic?.....Rum and blackcurrent?....Special sports drink?.....mine is plain tap water...... honestly. Sports drinks are big business now in the UK - last year we glugged down 91 million litres of isotonic, hypotonic, rehydrating fluids - enough to fill nearly 300 swimming pools! Add to that the energy drinks and protein shakes for body builders and you've got a multimillion pound sector. But do we need such drinks simply to do a THROB class? Well there is certainly performance enhancing benefits from using rehydrating drinks before, during and after exercise. If one is exercising sufficiently energetically to get the heart rate up then there is a measurable loss of body fluid by sweat, or in the case of the ladies, perspiration. It is not only water that we lose through sweat but also electrolytes, principally sodium and potassium, which are essential for the smooth operation of the body. These need to be replaced or muscles will find it harder to work, responses will be slower and exercise will be a lot less beneficial. It is said that most people turn up for an exercise session in a partially dehydrated state which means that you are lethargic and exercise will be harder. A ten-stone body needs an initial intake of about a pint of liquid and more should be consumed as the session progresses, about another pint should be sufficient. The sport drinks do have the edge over plain water in that they contain electrolytes. Apparently the brain monitors the level of sodium and potassium in the blood stream and if you drink too much plain water the signal goes out to the kidneys to eject water to restore the concentration of the electrolytes. Most re-hydrating sports drinks are simple concoctions of water glucose and electrolytes - you can make up your own version by simply adding salt to your orange squash! It might not get the optimal concentrations but it shouldn't do you any harm. People who want to build muscle take protein drinks after exercise to get the amino acids they contain. Thinking about it, I don't see anyone in my classes going in for the Mr. Universe contest so it is with a clear conscience that I leave consideration of the protein drinks - out!

David Read

(This piece was based on an article in the FT, brought to my attention by Michael Bader to whom I am most grateful. Ed.)

FAMILY INVOLVEMENT

Some time ago my Daily Telegraph had a report from the 2006 World Congress of Cardiology being held in Barcelona detailing a Europe wide study which said that heart patients eat more fruit and vegetables and take more exercise when their families become involved in their care. They are also more likely to stop smoking, reduce fat in their diets, and achieve lower cholesterol levels and lower blood pressure than people given routine care. These were the first reports of the Euroaction programme, which has involved 10,000 patients and family members. While most patients know the benefits of losing weight, taking exercise and a healthy diet, it is notoriously hard to get them to change their habits, even when diagnosed with a life-threatening illness. Intensive rehabilitation has been found to work but it is expensive and time consuming. The new approach involved a light touch, with patients attending group sessions at a hospital or using a practice nurse and the GP surgery, which proved as good as hospital attendance. The nurse would assess patients, give advice and phone families to encourage them and to see how they were getting on. "We think this worked because the whole family was committed. It was a family-based programme", said Professor David Wood, Chairman of the study and professor of cardiology at Charing Cross Hospital, London. Spouses were also encouraged to take part in regular exercise and three quarters agreed to do so.

Professor Wood, said that when the "shopper" was involved, the food on the table changed and the whole family benefitted. "When the people buying and preparing the food got the message it was much better than the patient coming home from hospital and saying he had to eat more fruit and vegetables, and trying to do that in isolation to the rest of the family," he added. Professor Wood said that analysis of the costs of the programme would be made next year and all the volunteers would be followed to measure future heart events or deaths.

In Britain, adopting such an approach across the NHS would need government action he said. For example, the widespread use of the healthy living programme would need to be included in GP contracts. Prof. Peter Weissberg, the medical director of the British Heart Foundation, said the proof of the programme would be to see if families maintained the change in habits after the first year. "The risk is that when the attention and the buzz has gone, people will drift back to their bad habits", he said. "However, a strategey based in the environment of the family is more likely to be successful"

This matter surprised me somewhat, since when I was undergoing the initial phases of rehabilitation back in the early nineteen nineties this was the approach adopted. The Cardiac Sister came round to the house to meet the family and to discuss your existing lifestyle and to suggest where changes needed to be made. Spouses were invited to the lectures which were given weekly over a period of six weeks to acquaint them with the problems the patient had acquired by contracting cadiac heart disease. Some time later the Monday evening class (still going) was set up with the idea that attendance by spouses was to be encouraged. So is the wheel being re-invented or are we well ahead of the field? Perhaps we were fortunate to have our cardiac problems in the Heatherwood/Wexham area - if you've got to have cardiac problems at all that is! Whatever the truth, it gives you that nice warm feeling that you've been doing it right all along and gives you the chance to review your lifestyle just in case you've let the standards slip - but you haven't....... have you?

BNP and Heart Failure

I have been asked by our esteemed Editor to write something about BNP. Now for those of you with political interests I'm sorry to disappoint you, as this has nothing whatsoever to do with the British National Party or my political affiliations which remain, as ever, a closely guarded secret along with all my other Liberal ideas!!! BNP in fact stands for Brain Natriuretic Peptide - or even more precisely N-terminal pro-brain natriuretic peptide... hmmm.... we'll just keep it to BNP shall we?

So what is it? It's a peptide (kind of protein) first found in the brain but also present in the ventricular muscle of the heart. When a person's heart begins to pump less efficiently ( heart failure) the body initially tries to compensate by raising the blood pressure and working the heart even harder to maintain a good circulation. All well and good until the heart muscle becomes even more fatigued and starts to enlarge and stretch eventually giving rise to an inefficient large floppy bag as opposed to a small efficient pump. In response to the stretch of the heart muscle BNP is released into the blood stream in increased amounts, so the value of BNP is for diagnostic purposes. Of course it's not quite as simple as that ( is it ever?) because raised BNP can also indicate a few other problems unrelated to the heart so it cannot be used as a positive marker. It can however be used as a negative marker.

What do we mean by a negative marker? To answer this we need to look at what happened with heart failure diagnosis prior to the use of the BNP blood test. If a patient had a number of the common symptoms of heart failure such as:

- breathlessness,

- weight gain,

- swollen ankles ( with pitting oedema),

- persistent cough,

- pink phlegm, and

- excessive tiredness,

among other possible diagnoses the doctor may suspect heart failure, so then the only course of action was to send the patient to see a consultant at the hospital and to have an Echocardiogram done. (Echocardigrams cost around £55 per patient and there is the additional cost to the NHS of the out-patient appointment.). After the 'echo' the patient could be told whether or not they had heart failure and if not, another explanation of the symptoms would have to be explored so it would be back to square one after several weeks of waiting for confirmation.

With the advent of the simple BNP blood test the first course of action in suspected heart failure is to do the test at the GP surgery and await the result which should only take a few days. (The blood test costs the NHS around £25 currently) If the blood test comes back as showing a normal range then there is a 90% + certainty that the patient has NOT got heart failure and therefore there is no point in sending him/her for an echo and another cause for the symptoms can be explored straight away. Heart failure is extremely unlikely if the level of BNP or NTproBNP is normal, especially if an ECG is also normal, so the diagnosis should be reconsidered in this situation. If the test comes back positive then the patient can be sent for an 'echo' to confirm the diagnosis of heart failure and to get more specific details about the extent of the problem.

Clearly this is much more efficient, cheaper and convenient for both doctor and patient. A pilot study using BNP testing was undertaken locally in 2005 and proved to be very successful so that it has now been officially adopted by the local Primary Care Trust and is available at your GP surgery. Although cheaper than an 'echo', it is still not a cheap blood test and is inappropriate for general screening. The symptoms of heart failure are diverse and can apply to lots of other conditions, especially respiratory problems, so a doctor is unlikely to be using the BNP test without careful thought and a genuine suspicion that heart failure may be on the cards. Most GP surgeries would only be doing this test occasionally and certainly not on demand but it has added to the ever increasing 'tools' available to GPs to give the best care to their patients.

Lesley Richards

MILK IN TEA

The benefits of the great British cuppa have been called into question by a German study which compared the effects on arteries by drinking tea with and without milk. It is claimed that caseins - proteins in milk - blocked the powerful effect of the flavinoids in tea that help protect the arteries and keep cardiovascular disease at bay. The Tea Council said that this was only a small study and they could point to other studies which show that milk does not inhibit the bio-activity of tea. Well they would say that, wouldn't they!

Oh DEAR! Oh DEAR! Oh ....um.....er....

People with bad memories and those with slow reaction times are more likely to die from heart attacks. This worrying fact comes from a twenty year study by Edinburgh University covering over 6,400 people from across Britain. It was found that those people with slower reaction times, poorer memory and poor visual-spatial awareness were linked to a higher chance of dying from cardiovascular or respiratory disease. Oh Dear!

David Read

PACEMAKER AND ICD SUPPORT GROUP

If you would be interested in joining a new support group for people with pacemakers or ICDs, please register either by telephoning Poonam or Jenny on 01753 633517 or by e-mailing poonam.chaudhary@hwph-tr.nhs.uk or by writing to Poonam Chaudhary at Cardiology Dept., Wexham Park HospitaL Wexham Street, Slough, Berks., SL2 4BL. Please give your name, address, telephone number and e-mail address.

The main aim is to get everybody involved and perhaps in the future pair up (buddy) old pacemaker patients with new ones who are anxious or who are going through a difficult period accepting the need for an implant and much more. It would be appreciated if you would pass this on to anybody you know who might be interested and who is not a current THROB member. All Exercise Class instructors please note!"

The support group will meet for the first time on Wednesday, 28th February 2007 from 6-8pm in the Board Room, Beech House, Upton Hospital, Slough. Your details will not be passed on without your permission.

Eddie Robson

I am very pleased to announce that I have passed my Masters Degree at Chester University As some of you may remember, I started this degree nearly three years ago and to date I have completed eight modules and a research dissertation. My degree has involved over 2000 hours of study time, which has covered a range of topics from the effects of strength training on the cardiovascular system to the investigations and interventions of angina.

The Grand Finale to my degree was a research dissertation, which looked at the physical activity patterns of Phase IV cardiac rehabilitation participants. This dissertation involved some of you completing a validated questionnaire, which was used to assess the amount of physical activity performed at a light, moderate and vigorous levels. Energy expenditure was also assessed. I would like to thank everyone who completed a questionnaire, which totalled more than 127. In the final analysis 106 were included in my study, 19 of whom were women. The study demonstrated the following: average age of the participants was 70 with the oldest being 86, the average length of time spent in Phase IV was 5 years with the longest being 15 years, and the average length time spent in light, moderate and vigorous activity was 5 hours, 3 hours and 30 minutes respectively. In addition, most participants attend at least two classes per week and the more popular activities performed outside the class environment were walking, cycling, swimming and gardening. The study concluded that the majority of people attending Phase IV cardiac rehabilitation participate in sufficient amounts of physical activity to meet current health guidelines, which will help modify coronary artery disease risk factors.

The main results of my study will be presented as the Tenth Annual THROB Lecture at the THROB AGM in the Spring and I trust you will all be there. Eventually I hope to get my study published, with the help of my university tutors, in a cardiac rehabilitation journal.

Tim Grove

Press release

Drinkers urged to look after their hearts this Valentine's Day

Thousands of beer mats are helping to spread potentially life-saving messages.

They are the latest initiative in the ongoing Heart Hero campaign launched in the Royal Borough towards the end of 2006 to help people respond more quickly when faced with a possible heart attack.

The 25,000 beer mats are being delivered to pubs and clubs in and around Windsor, Ascot and Maidenhead. The message that chest pain could be a heart attack needing an immediate 999 call has already been carried on hundreds of thousands of tickets issued by pay-and-display parking machines in the Royal Borough. Preliminary data appears to show more people are getting the message and calling the emergency services without delay.

Lesley Richards, a specialist cardiac nurse based at King Edward VII Hospital, Windsor, said: "We are trying to reach as many people as possible with the simple message that they must act quickly in response to chest pain. By doing the right thing in the 'golden hour' immediately after a heart attack, we can save lives, minimise damage to the heart and increase the chances of a full recovery."

The beer mats also carry advice on reducing risk factors for heart attacks – for example, highlighting the benefits of giving up smoking and exercising more.

THROB (The Heart Rehabilitation Organisation for Berkshire) funded the beer mats at a cost of £2,000. THROB committee member Anthony Stevens said: "We are wholeheartedly behind this excellent campaign. The messages around looking after your heart complement the work we are doing in our rehabilitation classes."

More information:

Martin Leaver, Berkshire East Primary Care Trust (PCT)

Tel: 07966 174 183 / 01235 553091 / 01753 636818

Notes to editors:

  1. A copy of the beer mat artwork is attached
  2. Photos are attached from the White Hart pub, Winkfield; we can set up something similar at a pub in Maidenhead to tie in with Valentine's Day
  3. Background information on the Heart Hero campaign can be found at www.hearthero.org.uk
  4. The 'Heart Heroes' project is a joint initiative bringing together a number of organisations including South Central Ambulance Service NHS Trust, Berkshire East Primary Care Trust and the Royal Borough of Windsor and Maidenhead. A local support group – THROB (The Heart Rehabilitation Organisation for Berkshire) – funded the beer mats. The initiative is also supported by an unrestricted educational grant from Sanofi Aventis and Bristol-Myers Squibb, who have no editorial input
  5. The Heart Hero campaign was launched locally just before the British Heart Foundation's national Doubt Kills campaign which has very similar aims and messages: www.bhf.org.uk/doubtkills/
  6. Top tips if you have chest pain:
  7. Call 999 – ask for Ambulance
  8. Describe symptoms
  9. Listen to advice
  10. Act as directed by Ambulance Control staff
THROB on Air

(or a day in the life of ..)

It seemed a good idea at the time. Well who can resist a young attractive female voice (especially with a French accent!) ? At my age the chance doesn't come very often ! She said she worked for Berkshire Radio and "somebody" had "fingered" me to talk about THROB in the 1.40 slot on Thursday 18th January. I knew I wasn't "first choice" but hang it all "beggars can't be choosers" as my old Dad used to say. The diary (Elizabeth's wall calendar in the kitchen) said I was " available". So I hastily agreed but no fee was mentioned - oh well ! In due course they sent me a few "potential questions - the answers to which were assembled from facts kindly supplied by Lesley Richards, David Read and members of the Committee. Elizabeth put me through my paces a couple of times and we thought with a fair wind I'd be OK. Fair wind indeed (!). When I examined the garden that Thursday morning I reckoned I could get away with replacing just one fence post if I was very careful ! Elizabeth decided that it would be advisable to delay our lunch until after the broadcast as Sid "on air" with two glasses of red under his belt would be just a wee bit risky ! 1.40 duly arrived, the telephone rang "on cue" and I was "standing by" (or rather sitting) and arranging my notes by the 'phone while Elizabeth took post in the kitchen in company with Radio Berkshire with her finger hovering over the "record" button. Suddenly I was introduced and I was "on air" chatting about THROB. Mercifully they stuck to the questions I'd been sent and gave me space to "plug" THROB's current "beer mat" venture and advertise our website. (My questioner discretely drew a veil over my suggestion to put THROB into Google to see what we got !). Then "thank you and goodbye" and I was back into the kitchen with a bit of a tremor and needing one of the glasses of red ! Dinner over and a ring comes on the doorbell - was it a fan who had just heard my broadcast ? No just my neighbour enquiring whether I could remove my tree from the bonnet of his car !!. Sure enough there it was - my age-old prunus tree right over the bonnet of his Mercedes resting one end on the gate post and the other on his wheeely bin astride the car's bonnet ! He reversed the car out and not a scratch !. Emboldened with two glasses of red, with confidence and a blunt chain saw I "set to" to remove the tree. Hopeless task !. Suddenly I was aware of a magic fairy behind me in the shape of a short slightly rotund man with "tree surgeon" written on his van. Price agreed - shake of the hands - off to the front room to take advantage of the two glasses of red ! The fence post could wait until tomorrow but that's another story of bruised hands and aching back removing a fence post stub from its concrete prison. But as I said on Berkshire Radio - we in THROB have "been there and got the Tee Shirt" (Brian Madge still has a few to sell !) and now we get on with "living" (little did I realise how true that was!)

Sid Barker