Leg Raising Exercises Can Improve Cardiac Microvascular Circulation

A patient in his 50s underwent three cardiac catheterizations and had six stents placed in his coronary arteries, yet still felt heart discomfort after his surgery. The patient even felt chest pain when crossing the road.

However, his surgery was a success—the stent was fully functional, and his aorta was also unobstructed. Later, it was discovered that the problem was poor microvascular circulation in the patient’s heart. Finally, the patient underwent ten sessions of enhanced external counterpulsation (EECP). His chest pain has healed and he can now run ten laps without any discomfort.

EECP is a non-invasive treatment that improves blood circulation throughout the body. In life, there is also a simple exercise that can promote cardiovascular health, so as to achieve the therapeutic effect of EECP.

Coronary Microcirculation Is Often Overlooked

The official journal of the American College of Cardiology recently pointed out that symptoms of heart discomfort that cannot be relieved after surgery and drug treatment in many heart disease patients may be related to cardiac microvascular dysfunction.

People tend to pay more attention to the coronary arteries in the treatment of cardiovascular diseases. However, the heart still has many small blood vessels, and their circulatory function was mostly neglected in the past, and it was not noticed until recent years.

Liu Chungpin, a cardiologist and the director of the Taiwan-based Yupin Clinic, pointed out that in some patients, the heart’s aorta is not significantly narrowed and the stent inserted in surgery is normal, but the cardiac muscle at the end does not receive sufficient blood supply due to blockage of the small blood vessels. As a result, angina pectoris or poor heart function may occur even after treatment.

All factors that cause stiffening of the large vessels also affect the small vessels. For example, smoking, high blood sugar, high cholesterol, changing weather, excessive stress, staying up late, bad mood, and lack of exercise can all cause microvascular thrombosis, hardening, or spasms.

However, current surgeries can only treat problems with large blood vessels. For example, for patients with myocardial infarction (heart attack), medical devices can only enter large blood vessels to remove thrombi, but they cannot reach small blood vessels. Thrombolytic drugs and anticoagulants are also unable to completely dissolve the thrombi in some small blood vessels.

In such cases, EECP can be used, which can increase cardiac blood flow without increasing cardiac workload, thereby improving myocardial metabolism and function. The method involves compressing and relaxing the legs with compression pants in sync with the heartbeat; while the heart is in its relaxed phase and its chambers are re-filling with blood, the blood is squeezed back to the heart from the calf and thigh, thereby increasing venous circulation and reducing arterial resistance. It increases coronary blood flow, thus relieving angina.

EECP’s 3 Main Mechanisms

1. Improved Blood Circulation

EECP can promote the blood circulation of the whole body and improve the microcirculation of the heart.

Huei-Fong Hung, the attending physician of the Division of Cardiology of Shin-Kong Wu Ho-Su Memorial Hospital in Taiwan, pointed out that the use of EECP can increase nitric oxide and decrease endothelin in the body in a short period of time. Nitric oxide relaxes blood vessels, while endothelin constricts them. These two changes lead to the dilation of blood vessels, thus improving the circulation of small blood vessels.

2. Increased Angiogenesis

Just like an alternative road can be used as a detour during a traffic jam, after the use of EECP in patients with vascular stenosis, an “alternative path” can be grown. This promotes the formation of collateral blood vessels, a process called angiogenesis.

Why can new blood vessels form? Liu Chungpin explained that when the cells on the vascular endothelium and heart muscle are dying due to insufficient blood, the increased blood flow and oxygen supply can increase the activating factors of the heart vessels, enhancing their cell regeneration ability.

3. Stabilized Vessel Walls

The act of squeezing the blood back increases the elasticity of the blood vessels.

The nitric oxide increased by EECP not only relaxes and dilates blood vessels, but also promotes the repair of vascular endothelial cells and prevents the hardening of blood vessels.

Huei-Fong Hung said that the improvement of blood circulation and the stabilization of blood vessel walls depend on endothelin and nitric oxide. However, the indicators of these two factors will gradually decrease after 2 to 3 months after completing EECP and return to the initial state after half a year. The only permanent effect is angiogenesis—once the collateral circulation is formed, it will remain there.

Good Coronary Microcirculation Can Improve Heart Disease

Improving the microcirculation of the heart is also beneficial for other heart diseases.

• Coronary heart disease: For those who suffer from chest tightness and pain due to stenosis (abnormal narrowing) of large blood vessels, the symptoms will also be relieved after the improvement of coronary microcirculation.
• Heart failure: This is associated with the heart muscles’ lack of strength and their inability to pump blood effectively. Liu Chungpin pointed out that one-third of heart muscle weakness is caused by insufficient blood flow. Therefore, when microcirculation is improved, heart failure caused by myocardial weakness can naturally be improved.
• Myocarditis: This is an acute inflammatory reaction of the heart muscles. Good cardiac microcirculation can help the recovery of myocarditis. If the heart muscles are deprived of oxygen during myocarditis, the patient’s heart recovery will be poor.

Cardiac microvascular circulation plays an important role in the heart diseases mentioned above, and one of the ways to improve it is through EECP.

Hung added that EECP can also treat many diseases clinically, such as stroke, sudden deafness, sudden blindness, vascular dementia, intestinal ischemia, diabetic nephropathy, and restless legs syndrome. He mentioned that post-stroke EECP treatment can substantially reduce the damage caused by a stroke.

This is because EECP also improves blood circulation in the whole body. Alongside the formation of collateral vessels, it can also improve the conditions caused by a vascular obstruction in the long term.

Improve Blood Circulation With Leg Raising Exercises

The duration of the effect of EECP also depends on whether the patient has implemented good lifestyle habits: exercise, smoking cessation, weight control, and keeping the blood pressure, cholesterol, and blood sugar levels normal.

EECP treatment requires the use of equipment to passively improve leg circulation and heart function. Usually, EECP is needed when the patient’s physical strength and heart are not yet capable of high-intensity exercise.

Liu Chungpin pointed out that if the patient is not too seriously ill and can still move around, it is recommended for him/her to do “leg raising exercises” including walking, running, cycling, and riding an exercise bike.

He explained that one-third of the blood flow in the human body is in the lower body, and strengthening the circulation of the legs can promote the circulation of the entire body. Contraction exercises, in which the feet are raised to increase the contraction of the thighs and calves, can send blood flow from the legs back to the heart, improving the microcirculation of the heart. People with cold feet can also improve blood circulation by exercising.

However, the quality of exercise is just as important. The heartbeat must reach more than 120 beats per minute in order for the heart to circulate adequately. Hung said that the effect of jogging for one hour is equivalent to EECP treatment; and exercise intensity, duration, and the formation of exercise habits are the key points.

On top of that, controlling blood pressure, cholesterol, and blood sugar levels is also very important. High blood pressure, cholesterol, and blood sugar levels can cause arteriosclerosis, resulting in vascular stenosis and aforementioned various diseases caused by poor blood circulation.

Hung drew a conclusion: regardless of whether the blood vessels are large or small, it is necessary to maintain cardiovascular health; in addition to exercising and controlling the blood pressure, cholesterol, and blood sugar levels, it is beneficial to minimize anger, sleeping late, and anxiety.

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