Exercise Helps the Heart and the Mind. But It Needs to Be Done Under the Right Guidance.

People with coronary artery disease don’t just face problems with their heart — anxiety and depression are much more common in this group. A large 2025 study examined 36 clinical trials and over 3,500 patients to see whether exercise helps, and whether it matters how it’s done.

The results were clear: exercise improved quality of life and significantly reduced anxiety and depression. However, these benefits were only seen when exercise was carried out under supervision and with proper guidance. Interestingly, the type of exercise (high-intensity or moderate) mattered far less than guidance, structure, and human interaction.

It is therefore very important that, after a cardiac event, exercise takes place in supervised sessions, which not only help the heart, but also meaningfully support mental health.

Reference:
Toval A, et al. Eur Heart J. 2025;46:2186–2201. doi: 10.1093/eurheartj/ehae870

Heart Rate Variability: A Simple Clue to a Longer, Healthier Life

Every heartbeat is followed by a slightly different gap before the next one, this natural variation is called “heart rate variability” (HRV). A study published in 2020 compared young people, people in their 80s, and people over 100 years old, and found that HRV tends to be higher in younger people and lower in older people. Among the people over 100 who were followed over time, those with higher HRV tended to live longer than those with lower HRV. This suggests HRV may be a simple marker of how resilient and healthy the body is, not just a number related to the heart.

The encouraging news is that HRV isn’t fixed, and that it can be improved. Better sleep, effective stress management, and regular aerobic exercise are all known to raise HRV over time. In other words, healthy daily habits may not just make you feel better, they may genuinely support a longer, healthier life.

You don’t need a hospital visit to check your HRV anymore. Many modern smartwatches and fitness trackers can measure it easily, right from your wrist. While these consumer devices aren’t a substitute for medical evaluation, they can be a helpful, motivating way to track how your lifestyle habits are affecting your body over time.

Reference:
Hernández-Vicente A, Hernando D, Santos-Lozano A, et al. Heart Rate
Variability and Exceptional Longevity. Front Physiol. 2020;11:566399. doi:
10.3389/fphys.2020.566399

When is a heart patient able to travel by plane?

Air travel is generally safe for most heart patients, provided that their condition is stable and managed by their doctor.

However, flight conditions (altitude, pressure, immobility) harbor specific risks that can strain the cardiovascular system.

Although the airplane cabin is pressurized, air pressure at high altitudes is lower than on the ground. This slightly reduces blood oxygen levels, forcing the heart to beat faster to cope. In individuals with coronary artery disease, heart failure, or pulmonary hypertension, this change can cause shortness of breath or angina (chest pain).

Prolonged immobility in a confined space, combined with dehydration, significantly increases the risk of blood clots forming in the legs.

The stress of travel, delays, standing in security lines, and carrying luggage release stress hormones. These can cause a sudden spike in blood pressure and heart rate, increasing the likelihood of arrhythmias or ischemic episodes.

There are specific cases where flying may be contraindicated until the patient’s condition stabilizes, such as:

1. Recent myocardial infarction (recovery periods often range from 1 to 4 weeks depending on severity and complications).
2. Unstable angina (chest pain that occurs even at rest).
3. Uncontrolled heart failure.
4. Severe, uncontrolled arrhythmias.
5. Recent heart surgery (recovery periods often range from 4 to 6 weeks).

If a cardiologist gives their approval for the trip, patients are generally advised to follow these instructions:

1. Proper hydration: Drink plenty of water during the flight. Strictly avoid alcohol and caffeine, as they can exacerbate dehydration and increase heart rate.
2. Mobility: Stand up and walk in the aisle for a few minutes every 1-2 hours.
3. Medication Management: Always keep all medications in the airplane cabin (not in checked luggage) and carry an amount greater than the intended duration of the trip.

Can a stress test reveal Brugada syndrome?

Brugada syndrome is an inherited form of arrhythmia, in which despite the heart being structurally completely normal, dangerous arrhythmias can occur under certain conditions.

Diagnosis is typically made with the resting electrocardiogram (ECG), which detects a characteristic abnormality. However, in some cases this subtle anomaly remains hidden within the ECG. If there is a clinical suspicion, this specific ECG alteration can be unmasked using a specialized pharmacological provocation test (ajmaline challenge).

Genetic testing can also provide diagnostic support. The most common gene associated with the disease is SCN5A (responsible for 20-30% of cases).

A stress test (exercise tolerance test) is another examination that few people know can assist in establishing the diagnosis of Brugada syndrome. Specifically, in an individual with suspected Brugada syndrome and a normal resting ECG, the recovery phase of the stress test can reveal the characteristic abnormality, particularly in a supine position using "high precordial leads." The transition from exercise to rest, under conditions dominated by parasympathetic tone (vagally-induced), appears to facilitate the unmasking of concealed electrocardiographic abnormalities of the syndrome in approximately 25% of cases.

Reference:
Exercise and Exercise Stress Testing in Brugada Syndrome: Diagnostic, Prognostic, and Safety Implications
https://doi.org/10.1016/j.jacasi.2026.03.021

Physical activity after a heart attack : how soon is safe to start

Physical activity is essential to be done regularly in patients with coronary heart disease, because it substantially reduces the risk of recurrent cardiac events.

However, most physicians recommend to initiate exercise after a month has passed after the episode.

A recent study demonstrates that patients who have had a heart attack may be able to engage in physical activity within a week after hospital discharge.

This was prospective cohort study, which enrolled 165 patients (average age 65, 65% men) who had myocardial infarction (MI). A thigh-worn accelerometer was used to monitor their activity during the first week after they were discharged.

According to the authors early post-discharge activity appears to be safe. This reinforces the idea that early mobilization and promotion of physical activity could become a more central component of post-MI care

Reference:
American Journal of Preventive Cardiology
Available online 17 April 2026, 101641
Pre- and post-discharge physical activity in acute myocardial infarction: Relation to
clinical events across 5-year follow-up

Atrial fibrillation after by-pass surgery (CABG) : anticoagulants or maybe not?

Atrial fibrillation is an arrhythmia that occurs commonly after by-pass surgery (CABG). It is estimated to happen in 30% of operated patients. It is often transient and normal rhythm is restored, either spontaneously or with a medical intervention.

New findings question the need for lifelong oral anticoagulants for patients who develop atrial fibrillation AF after CABG, showing that although the arrythmia may be more frequent than previously estimated, the overall burden of arrhythmia is negligible after the firs 30 days.

The study, published in JAMA, demonstrated that while nearly half of 198 patients who underwent CABG developed AF within a year of the surgery, the median burden of arrythmia events was well less than 1%.

According to the authors, it is reasonable to assess these patients about 30 days after CABG surgery with a HOLTER rhythm monitor. Depending on the overall burden of AF it can be decided whether lifelong anticoagulation therapy is needed or not.

Reference:
Long-Term Continuous Monitoring of New-Onset Atrial Fibrillation After Coronary
Artery Bypass Grafting
JAMA. Published Online: October 9, 2025

Cardiologists appear to be non-compliant to lifestyle recommendations

A very interesting study demonstrates that cardiologists do not adhere to their own recommendations, regarding diet, exercise, alcohol consumption, stress management and sleep.

According to the researchers, only 8% of cardiologists complied to a whole-food, plant- based diet.

Only 69% of the sample said they met physical activity requirements (at least 150 minutes weekly).

The overwhelming majority of respondents (92%) said they abstained from tobacco use, 69% reported drinking, and 34% said they did so on a weekly basis.

On average, cardiologists reported sleeping 6.8 hours per night. However, 35% indicated dissatisfaction with their sleep patterns.

Cardiologists need to become more compliant to the recommendations about lifestyle, in order to protect their health, which is already jeopardized by the heavily stressful environment of their specialty.

Reference:
Dietary and Lifestyle Habits of Cardiologists: Perception vs Practice
JACC Journals, 25 August 2025