FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

AFTER HEART ATTACK: HANG UP YOUR SNOW SHOVEL AND HIRE A TEENAGER

Question: My husband had a heart attack last spring. He is doing fine now. He exercises regularly, watches his diet, and has lost weight just as the doctor ordered. The doctor said that Jim shouldn't shovel snow this year, but why is this different from other vigorous activity that he can do? Also, is a snow blower safe for him to use?

Answer: Shoveling snow is vigorous work, or it certainly can be, and this puts a commensurate high demand upon the heart. Since your husband has already had one heart attack, it is wise to limited exercise to a level that strengthens his heart without overdoing it. This proper level of exercise is often difficult to judge.

Shoveling show requires bending over, pushing and lifting. These actions require movements that most of us don't do routinely and, therefore, aren't conditioned to do for extended periods. The amount of exertion necessary for just a little shoveling, such as clearing off the front steps, is generally safe if done at a slow and methodical pace. Since the snow falls not just on the front steps but also on the walk and driveway, the potential for exceeding a safe exercise level certainly exists. I'm sure you know that for most of us it is difficult to stop and rest before the job is done especially when one feels fine. And "feeling fine" isn't a safe way to predict an allowable level of exertion for someone with a previously injured heart. Exceeding this level can cause another heart attack.

Being outside in the cold causes complex changes in our physiology. Of particular concern for your husband is the increased demand cold temperatures alone without regard to any work being done place upon the heart. As an example, individuals who have angina (heart pain) with moderate exertion indoors often have it standing still when the temperature hovers near zero.

Shoveling snow places significant demand upon the heart because of the amount of work being done and because it is done in the cold. A snow blower MAY reduce the amount of physical exertion. I say "may" because I've used cumbersome ones that took considerable effort to "muscle" around. Others operate with "fingertip ease" and, therefore, create less demand upon the heart.

Regardless of the machinery used, shoveling snow is potentially dangerous work for someone with heart disease. I'd suggest following your doctor's advice. The consequence of stepping or shoveling over that line separating safe and unsafe levels of exertion in the cold is just too great. Hire the neighbor's teenager to do your walk and driveway instead. He or she will be thrilled to have a few extra dollars, and your husband will avoid the risk of another heart attack.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.