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1) Stroke: Prevention and
Treatment
2) Don't Take it Easy -
Exercise!
3) How to Measure Your
Heart Rate
4) High Blood Pressure A
Common but Controllable Disorder
5) Stroke: Prevention and
Treatment
Stroke: Prevention and Treatment
- Thanks to new tests
that help predict strokes, treatments that help control high blood
pressure, and good health habits that many Americans are practicing,
the death rate from strokes is down as much as 50 percent since
1970. Still, strokes are the third leading cause of death in the
United States and the leading cause of disability among adults.
What Is a Stroke?
A stroke is a sudden
partial loss of brain function usually caused by a clot that stops
the flow of blood to an area of the brain. Without oxygen and
important nutrients, the affected brain cells are either damaged or
die within a few minutes.
While cell damage can be repaired and the lost functions regained,
the death of brain cells is permanent. Most strokes are caused by a
blood clot or narrowing of a blood vessel (artery) leading to the
brain. Other strokes are caused by a hemorrhage (bleeding) from an
artery. There are three major types of strokes:
Thrombotic strokes
are caused by fatty deposits (plaques) that
have built up in the arteries carrying blood to the brain. This
slows the blood flow until a blood clot completely blocks the artery
and the flow of oxygen and nutrients to the brain.
An
embolic stroke
is caused by a blood clot formed in
another part of the body that breaks loose, travels through the
bloodstream, and blocks an artery carrying oxygen and nutrients to
the brain. When traveling through the body the blood clot is called
an embolus.
A
hemorrhagic stroke is
caused when an artery supplying blood bleeds into the brain. The
broken blood vessel prevents needed oxygen and nutrients from
reaching the brain cells. One type of hemorrhagic stroke is caused
when an artery that has weakened over time bulges (called an
aneurysm) and suddenly breaks.
Diagnosis and
Treatment
A stroke requires
immediate medical care. Research shows that treatment during the
first hours after symptoms appear can be important for the best
possible recovery. An emergency doctor or neurologist (a doctor who
diagnoses and treats disorders of the brain and nervous system) will
provide emergency treatment. Then a family doctor, internist, or
geriatrician can step in and provide longer term care.
Doctors make an early diagnosis by looking at symptoms, reviewing
the patient’s medical history, and performing tests such as a
computerized tomography scan--a 3-dimensional x-ray technique to
take pictures of the brain.
What You Can do to
Prevent a Stroke
A stroke was once
viewed as a single damaging attack, but we now know it develops over
many years. The risk factors or conditions that may lead to stroke
include high blood pressure, smoking, heart disease, and diabetes.
The risk of stroke increases with age and is higher in African
Americans and Hispanics than in whites.
You can reduce your stroke risk by taking the following steps:
- Control your blood
pressure. Have your blood pressure checked often, and, if it is
high, follow your doctor’s advice on how to lower it. Treating
high blood pressure reduces the risk for both stroke and heart
disease.
- Stop smoking.
Cigarette smoking is linked to increased risk for stroke. Research
shows that the risk of stroke for people who have quit smoking for
2-5 years is lower than for smokers.
Exercise regularly.
Researchers think that exercise may make the heart stronger and
improve circulation. It also helps control weight. Being overweight
increases the chance of high blood pressure, atherosclerosis, heart
disease, and adult-onset (type II) diabetes.
Physical activities like brisk walking, cycling, swimming, and yard
work lower the risk of both stroke and heart disease. Talk with your
doctor before starting an exercise program.
- Eat a healthy diet.
Choose, prepare, and eat foods low in fats, saturated fatty acids,
and cholesterol. Eat a variety of fruits and vegetables.
- Control diabetes. If
untreated, diabetes can damage the blood vessels throughout the
body and lead to atherosclerosis.
- Promptly report
warning signs or symptoms to your doctor. The warning signs for
stroke are a sudden, unexplained tingling and/or numbness on one
side of the body, a sudden severe headache, blurred vision,
difficulty talking, stumbling and/or sudden clumsiness. Sometimes
a mini-stroke, lasting only a few moments and called a transient
ischemic attack (TIA), comes before a stroke.
Rehabilitation for
Stroke
Rehabilitation should
begin as soon as possible after the patient is stable. It often
continues after the patient has gone home. Stroke rehabilitation
includes many kinds of therapies: physical therapy to strengthen
muscles and improve balance and coordination; speech and language
therapy; and occupational therapy to improve eye-hand coordination
and skills needed for tasks such as bathing and cooking. A team of
health care experts (physicians, physical and occupational
therapists, nurses, social workers, and speech and language
specialists) coordinates activities for the patient and family.
Rehabilitation progress varies from person to person. For some,
recovery is completed within weeks following a stroke; for others,
it may take many months or years.
National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
Don't
Take it Easy - Exercise!
Whether you’re 40 or 60
years old, you can exercise and improve your health. Physical activity
is good for your heart, mood, and confidence. Exercising has even
helped 80 and 90 year old people living in nursing homes to grow
stronger and more independent. Older people who become more
active--including those with medical problems--may feel better and
have more energy than ever before.
Why Should I Exercise?
Staying
physically active is the key to good health well into later years. Yet
only about 1 in 4 older adults exercises regularly. Many older people
think they are too old or too frail to exercise.
Nothing could be further from the truth. Physical activity of any
kind--from heavy-duty exercises such as jogging or bicycling to easier
efforts like walking--is good for you. Vigorous exercise can help
strengthen your heart and lungs. Taking a brisk walk regularly can
help lower your risk of health problems like heart disease or
depression. Climbing stairs, calisthenics, or housework can increase
your strength, stamina, and self-confidence. Weight-lifting or
strength training is a good way to stop muscle loss and slow down bone
loss. Your daily activities will become easier as you feel better.
Researchers now know
that:
- Regular, active
exercise such as swimming and running, raises your heart rate and
may greatly reduce stiffening of the arteries. Stiff arteries are a
major cause of high blood pressure, which can lead to heart disease
and stroke.
- People who are
physically active are less likely to develop adult onset diabetes,
or they can control it better if they do have it. Exercise increases
the body’s ability to control the blood glucose level.
- Regular activity, such
as walking or gardening, may lower the risk of severe intestinal
bleeding in later life by almost half.
- Strength training,
like lifting weights or exercising against resistance, can make
bones stronger, improve balance, and increase muscle strength and
mass. This can prevent or slow bone-weakening osteoporosis, and may
lower the risk of falls, which can cause hip fractures or other
injures.
- Strength training can
lessen arthritis pain. It doesn’t cure arthritis, but stronger
muscles may ease the strain and therefore the pain.
- Light exercise may be
good for your mental health. A group of healthy, older adults said
they felt less anxious or stressful after exercising for one year.
What Kind of Exercise
Should I Do?
Physical
activity and exercise programs should meet your needs and skills. The
amount and type of exercise depends on what you want to do. Different
exercises do different things: some may slow bone loss, others may
reduce the risk of falls, still others may improve the fitness of your
heart and lungs. Some may do all three.
You can exercise at home alone, with a buddy, or as part of a
group. Talk to your doctor before you begin, especially if you are
over 60 or have a medical problem. Move at your own speed, and don’t
try to take on too much at first. A class can be a good idea if you
haven’t exercised for a long time or are just beginning. A qualified
teacher will make sure you are doing the exercise in the right way.
It may take a little effort to make exercise a regular part of
your life. Once you start, try to stick with it. If you stop
exercising, after awhile, the benefits disappear.
One good way to stay active is to make physical activity part of
every day. Thirty minutes of moderate activity each day is a good
goal. You don’t have to exercise for 30 minutes all at once. Short
bursts of activity, like taking the stairs instead of the elevator, or
walking instead of driving, can add up to 30 minutes of exercise a
day. Raking leaves, playing actively with children, gardening, and
even doing household chores can all be done in a way that can count
toward your daily total.
It’s a good idea to include some stretching, strength training,
and aerobic or endurance exercise in your exercise plan. People who
are weak or frail, and may risk falling, should start slowly. Begin
with stretching and strength training; add aerobics later. Aerobics
are safer and easier once you feel balanced and your muscles are
stronger.
Stretching--improves
flexibility, eases movement, and lowers the risk of injury and muscle
strain. Stretching increases blood flow and gets your body ready for
exercise. A warm-up and cool-down period of 5 to 15 minutes should be
done slowly and carefully before and after all types of exercise.
Stretching can help loosen muscles in the arms, shoulders, back,
chest, stomach, buttocks, thighs, and calves. It’s also very relaxing.
Strength Training
(also called resistance training or
weight-lifting)--builds muscle and bone, both of which decline with
age. Strengthening exercises for the upper and lower body can be done
by lifting weights or working out with machines or an elastic band. It
is very important to have an expert teach you how to work with
weights. Without help, you can get hurt. With help, older adults can
work their way up to many of the same weight-lifting routines as
younger adults. Once you know what to do, simple strength training
exercises can be done at home. For beginners, household items, such as
soup cans or milk jugs filled with water or sand, can be used as
weights.
Strength training activities do not have to take a lot of
time; 30 to 40 minutes at least two or three times each week is all
that’s needed. Try not to exercise the same muscles two days in a row.
Sample Strength
Training Plan
(Always check with your
doctor first. Work with a qualified teacher to make sure you are doing
the exercise right.)
1.Start with a weight
you can lift without too much effort five times.
2.When you can easily do that, lift it five times, rest a few
minutes, then do it again. (This is two sets.)
3.Increase to three sets.
4.When you can easily do that, lift the weight 10 times in each set.
5.When you can easily do that, lift the weight 15 times in each set.
6.Once that’s easy, slowly increase the weight.
Aerobic exercises
(also called endurance exercises)--strengthen the heart and
improve overall fitness by increasing the body’s ability to use
oxygen. Swimming, walking, and dancing are "low-impact" aerobic
activities. They avoid the muscle and joint pounding of more
"high-impact" exercises like jogging and jumping rope.
Aerobic exercises raise the number of heart beats each minute
(heart rate). It’s best to get your heart rate to a certain point and
keep it there for 20 minutes or more. If you have not exercised in
awhile, start slowly. As you get stronger, you can try to increase
your heart rate. Aerobics should be done for 20 to 40 minutes at least
three times each week.
National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
How
to Measure Your Heart Rate
Your heart rate tells how many times your heart
beats each minute. The maximum heart rate is the fastest your heart
can beat. Exercise above 75% of that rate is too much for most people.
You can figure out the number of times your heart should beat each
minute during exercise (your personal "target" heart rate), with the
following guidelines and just a little bit of math.
Look for the age category closest to your age in the table below and
read the line across:
Age Target Heart
Rate Zone Average Maximum
Heart Rate
55 50-75% 100%
60 80-120 165
65 83-123 160
70+ 75-113 155
For example, if you are 60 years old, your target zone is 80-120 beats
per minute.
When you begin your exercise program, choose the lowest level in the
zone closest to your age and keep your heart rate at that level for
the first few months. As you get into better shape, you can slowly
build up to a higher level.
To see if you are within your target heart rate zone, measure your
heartbeats right after exercising. One good way is to place the tips
of your first two fingers on the inside of your wrist, just below the
bottom of your thumb. Count your pulse for 10 seconds and then
multiply by six to find the number of beats per minute. If you are
below your target zone, you may want to exercise a little harder next
time. Slow down if you are above your target zone.
Before starting any aerobics program, check with your doctor and ask
about your own target heart rate. Some blood pressure medicines, for
example, can affect how you figure out your target heart rate.
National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
High
Blood Pressure A Common but Controllable Disorder
You may be surprised if
your doctor says you have high blood pressure (HBP) because it does
not cause symptoms and you can have it even though you feel fine. But
HBP is a serious condition that can lead to stroke, heart disease,
kidney failure, and other health problems. The good news is that there
are simple ways to control it.
What Is HBP?
As blood flows
from the heart out to the blood vessels, it creates pressure against
the blood vessel walls. Your blood pressure reading is a measure of
this pressure. When that reading goes above a certain point, it is
called high blood pressure. Hypertension is another name for HBP.
As many as 50 million Americans may have HBP. Among people age 65
and older, about 40 percent of Whites and 50 percent of Blacks have
HBP.
How Is It Tested?
To test blood
pressure, a doctor or nurse places a cuff around your arm above the
elbow, pumps air into the cuff, and then reads the measurements as the
air is let out. The test is painless and takes only a few minutes.
Your blood pressure measurement may be taken several times. You
may be asked to stand one time and sit another. If your blood pressure
is high the first day, the doctor will want measurements from
different days before deciding whether you really have high blood
pressure. These steps are needed because blood pressure changes so
quickly. Also, it is affected by many things, including the normal
feelings of worry during a visit to the doctor.
Because HBP is so common, everyone should have his or her blood
pressure tested once a year. Blood pressure readings are given in two
numbers. Although the average blood pressure reading for adults is
120/80, a slightly higher or lower reading (for either number) may not
be a problem. If blood pressure goes above 140/90, however, some form
of treatment diet or drugs may be needed. Lower blood pressure
readings (for example, 110/70) are thought to be safe for most people.
What If Just The
First Number is High?
Often in older
adults the first number (the upper or systolic number) is high while
the second (the lower or diastolic) number is normal. This condition
is called isolated systolic hypertension, and it also should be
treated. Studies prove that lowering the systolic number cuts down on
strokes and heart attacks in people age 60 and over.
What Causes HBP?
Some cases of HBP
are caused by other illnesses. This kind of HBP is called secondary
hypertension, and it is often cured once the original medical problem
is cured. Most HBP, however, is essential or primary hypertension.
This kind cannot be cured but can be kept under control by regular,
ongoing treatment.
Doctors think that many things combine to cause HBP. Being
overweight, drinking too much alcohol, and eating too much salt are
risk factors because they raise your risk of having HBP. They do not
cause it directly.
Blood pressure goes up in all people during periods of stress or
exercise. But avoiding stress will not prevent high blood pressure.
You can have HBP even though you are usually a calm, relaxed person.
How Is HBP Treated?
If you have mild HBP,
your doctor may suggest that you lose weight and keep it off, eat less
salt, cut down on alcohol, and get more exercise. You may bring your
blood pressure down simply by following this advice. Even if medicine
is needed, these daily habits may help it work better.
Some people think that when their blood pressure comes down, they
no longer need treatment. If your doctor has prescribed medicine, you
may have to take it for the rest of your life. Later on, though, you
may be able to take less of it.
Can HBP Be
Prevented?
There is now good
evidence that HBP can be prevented in many people. The keys to
prevention are:
- Keeping your weight
moderate;
- Cutting down on salt;
- Exercising regularly;
and
- If you drink, having
no more than two drinks a day.
HBP Checklist
- HBP may not make you
feel sick, but it is serious and should be treated by a doctor.
- You can bring down
your blood pressure with changes in diet and daily habits and by
taking medicines if necessary.
- Losing weight, cutting
down on salt and alcohol, and getting regular exercise may be
helpful, but only as suggested by your doctor. Do not assume these
are substitutes for medicine unless your doctor says they are.
- If one day’s dose of
medicine is missed, do not double up the next day. Instead, call
your doctor for advice.
- Take your medicine at
the same time each day-for example, in the morning or evening after
brushing your teeth to help set a regular, easy to remember routine.
National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
Stroke: Prevention and Treatment
- Thanks to new tests
that help predict strokes, treatments that help control high blood
pressure, and good health habits that many Americans are practicing,
the death rate from strokes is down as much as 50 percent since
1970. Still, strokes are the third leading cause of death in the
United States and the leading cause of disability among adults.
What Is a Stroke?
A stroke is a sudden
partial loss of brain function usually caused by a clot that stops
the flow of blood to an area of the brain. Without oxygen and
important nutrients, the affected brain cells are either damaged or
die within a few minutes.
While cell damage can be repaired and the lost functions regained,
the death of brain cells is permanent. Most strokes are caused by a
blood clot or narrowing of a blood vessel (artery) leading to the
brain. Other strokes are caused by a hemorrhage (bleeding) from an
artery. There are three major types of strokes:
Thrombotic strokes
are caused by fatty deposits (plaques) that
have built up in the arteries carrying blood to the brain. This
slows the blood flow until a blood clot completely blocks the artery
and the flow of oxygen and nutrients to the brain.
An
embolic stroke
is caused by a blood clot formed in
another part of the body that breaks loose, travels through the
bloodstream, and blocks an artery carrying oxygen and nutrients to
the brain. When traveling through the body the blood clot is called
an embolus.
A
hemorrhagic stroke is
caused when an artery supplying blood bleeds into the brain. The
broken blood vessel prevents needed oxygen and nutrients from
reaching the brain cells. One type of hemorrhagic stroke is caused
when an artery that has weakened over time bulges (called an
aneurysm) and suddenly breaks.
Diagnosis and
Treatment
A stroke requires
immediate medical care. Research shows that treatment during the
first hours after symptoms appear can be important for the best
possible recovery. An emergency doctor or neurologist (a doctor who
diagnoses and treats disorders of the brain and nervous system) will
provide emergency treatment. Then a family doctor, internist, or
geriatrician can step in and provide longer term care.
Doctors make an early diagnosis by looking at symptoms, reviewing
the patient’s medical history, and performing tests such as a
computerized tomography scan--a 3-dimensional x-ray technique to
take pictures of the brain.
What You Can do to
Prevent a Stroke
A stroke was once
viewed as a single damaging attack, but we now know it develops over
many years. The risk factors or conditions that may lead to stroke
include high blood pressure, smoking, heart disease, and diabetes.
The risk of stroke increases with age and is higher in African
Americans and Hispanics than in whites.
You can reduce your stroke risk by taking the following steps:
- Control your blood
pressure. Have your blood pressure checked often, and, if it is
high, follow your doctor’s advice on how to lower it. Treating
high blood pressure reduces the risk for both stroke and heart
disease.
- Stop smoking.
Cigarette smoking is linked to increased risk for stroke. Research
shows that the risk of stroke for people who have quit smoking for
2-5 years is lower than for smokers.
Exercise regularly.
Researchers think that exercise may make the heart stronger and
improve circulation. It also helps control weight. Being overweight
increases the chance of high blood pressure, atherosclerosis, heart
disease, and adult-onset (type II) diabetes.
Physical activities like brisk walking, cycling, swimming, and yard
work lower the risk of both stroke and heart disease. Talk with your
doctor before starting an exercise program.
- Eat a healthy diet.
Choose, prepare, and eat foods low in fats, saturated fatty acids,
and cholesterol. Eat a variety of fruits and vegetables.
- Control diabetes. If
untreated, diabetes can damage the blood vessels throughout the
body and lead to atherosclerosis.
- Promptly report
warning signs or symptoms to your doctor. The warning signs for
stroke are a sudden, unexplained tingling and/or numbness on one
side of the body, a sudden severe headache, blurred vision,
difficulty talking, stumbling and/or sudden clumsiness. Sometimes
a mini-stroke, lasting only a few moments and called a transient
ischemic attack (TIA), comes before a stroke.
Rehabilitation for
Stroke
Rehabilitation should
begin as soon as possible after the patient is stable. It often
continues after the patient has gone home. Stroke rehabilitation
includes many kinds of therapies: physical therapy to strengthen
muscles and improve balance and coordination; speech and language
therapy; and occupational therapy to improve eye-hand coordination
and skills needed for tasks such as bathing and cooking. A team of
health care experts (physicians, physical and occupational
therapists, nurses, social workers, and speech and language
specialists) coordinates activities for the patient and family.
Rehabilitation progress varies from person to person. For some,
recovery is completed within weeks following a stroke; for others,
it may take many months or years.
National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health |
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