The curious writing habits of Ernest Hemingway, vanishing sphygmomanometers and the perils of 11-inch plates ... for mental stimulation, there’s nothing quite like a health check at Croí, the west of Ireland cardiology foundation.
It’s a Monday morning, and I am one of two journalists who have signed up for a physical NCT at Croí’s heart and stroke centre in Galway – opened two years ago and the only one of its type in the State. So there we were, in our lustrous Lycra, with physical activity specialist Caroline Costello, and there was she, gearing up to put us to the test.
“This works better if neither of you have done any vigorous exercise before you came here,” Costello explained.
"Don't worry," my fellow traveller, Connacht Tribune journalist Bernie Ní Fhlatharta, reassured her. "I've done nothing this morning, not even sex."
Moments before, we’d been comparing notes about the benefits of vertical living. Costello cited recent research conducted on a group of British estate agents which showed that standing is good for long-term health.
“Current evidence shows that people who stand for most of their working day have a 15 per cent reduced risk of premature death compared with those who sit for most of their day,” she said, as we contemplated the toll taken by all those years of feeding voracious newsdesks.
Hemingway could have told them a thing or two, Ní Fhlatharta mused. Didn’t he write all his novels standing up? It turns out that Kierkegaard, Virginia Woolf and Charles Dickens also preferred to be on their feet.
Women are prime candidates for this type of assessment, Croí prevention nurse lead and programmes manager Irene Gibson had explained on our arrival. Contrary to popular perception, more Irish women die of cardiovascular disease (CVD) than of breast cancer every year.
Some 90 per cent of heart disease and stroke is due to risk factors such as smoking, physical activity or lack of it, diet and weight. As Gibson noted, “that means 90 per cent of it is preventable”.
On that sobering thought, our two-hour assessment began with individual CVD and diet analysis. So, while Ní Fhlatharta was in one room talking about breakfast, Gibson explained to me how the CVD check involved taking a blood sample, blood pressure and pulse.
All of this information would be fed into a “Heartscore” database, modelled on European Society of Cardiology guidelines, which calculates overall risk.
The blood sample was painless – a tiny finger prick – and it took just 10 minutes to analyse it for its cholesterol content. The total cholesterol count is only part of the equation, Gibson noted.
The breakdown between HDL or “good”cholesterol, LDL or “bad” cholesterol and triglycerides helps to paint a complete picture of risk factors.
High blood pressure affects some 50 per cent of the population over 50 years of age, Gibson explained, as she then asked me to roll up the sleeves of both arms. Pressure can sometimes vary from one arm to the other, and best practice involves remaining silent and keeping both feet on the floor.
Gibson attached a sensor to my finger to take my pulse. She also checked my wrist manually, explaining that this is the best indicator of any irregular heart rhythm. The old stethoscope and mercury sphygmomanometer routine was phased out due to the mercury risk.
Another pause here to talk about sphygmomanometers – the pump, dial, cuff and valve device once used to measure blood pressure – and “white coat hypertension” syndrome, where a patient’s pressure can elevate on knowing it is about to be taken.
Then the blood samples arrived. My cholesterol total was 5.78, and should be less than five, she told me. However, as I looked for the nearest exit, Gibson had some soothing words. My HDL or “good cholesterol” reading was so positive, at 2.59, that the LDL or “bad cholesterol” element gave no reading at all.
Exercise tends to push HDL levels up, Gibson said. Those tortuous Turkish sit-ups during kettlebell routines must be worth it after all.
My triglycerides had also “passed”, as had blood pressure and pulse. Gibson keyed the figures into Heartscore, which also took into account my non-smoking status. It gave me a zero per cent 10-year CVD risk result. We decided to try an alternative scenario test, and so she keyed in figures that were almost identical, but gave a higher blood pressure and listed me as a smoker. The overall result was three times higher, while my relative risk was multiplied by six.
My reward was a “safe heart” card,which listed the actual and target readings, including body mass index and that elusive 32-inch waist. We swapped rooms. Bernie was smiling. The signals for the next session with Croí dietitian Claire Kerins looked good.
My eating under the spotlight
My typical eating day was nothing to boast about, however, especially if living off sandwiches on the road. That virtuous behaviour at breakfast – a bowl of granola – was akin to “eating ice-cream”, Kerins said. Her advice was a switch to Weetabix, or porridge as next best.
Next came weight, height and waist circumference measurements. Kerins estimated that my target body mass index should be 25. Thankfully, it was close enough. However, three uninvited inches had somehow landed on my waist. This had to be a mystery of sorts.
The World Health Organisation (WHO) waist targets are “quite strict”, Kerins acknowledged – but one had the sense she wasn’t quite letting me off the hook. “Cut out the cheese,” she said, and my heart sank like a stone.
We talked about salt, portions, and the health hazard that is 11-inch plates. “We should all be using nine-inch plates for our main meal, but restaurants have brought in bigger,” Kerins said.
As for those grandparents who scolded us for not finishing up our dinners, it seems we should have been scolding them for inculcating long-term risks to health.
“When the child hears that sort of reprimand, he or she stops listening to internal signals and only [listens] to external ones,” Kerins explained. “The result is an inability to know when the tummy is actually full.”
Kerins’s parting gifts included a handy guide to food labels with a “traffic light” scoring of sugars, fat, saturates and salt measures. All this talk was giving me an appetite. However, Caroline Costello was waiting for us upstairs in the gym.
Exercises for home
The Croí gym is not all wall-to-wall treadmills and training machines. Rather, it is equipped with steps, hand-held weights and bands, and a large space for circuits. The keeping-it-simple concept is based on ensuring that tailored physical activity programmes can be replicated at home.
Our test involved 10 minutes of step-ups, set to a rate that would increase five times every two minutes. It aimed to take us to 70 per cent of our heart reserve. At each interval, Costello and her assistant would take our pulse, and ask us to assess difficulty on the Borg exertion level scale.
Structured exercise to a moderate level is an ideal protection against heart disease, Costello said afterwards as she analysed the results. However, the body is clever, adjusting to routine, so variety and intensity are key.
The combination of exercise and diet is imperative, she said. One is “the king, one the queen, and both together make up an impressive empire”, she explained.
We had earned our coffee, and our “Croí-approved” plate of biscuits. I dived into a fig roll. My far more disciplined companion refused.
“This type of education about our eating habits and exercise should be taught at a much earlier age,” Ní Fhlatharta noted. Her own cholesterol reading had filled her with new resolve.
“Most would think nutrition is common sense, but it’s obvious with our obesity statistics and heart attack deaths that many of us are eating the wrong foods,” she said.
“Everyone should do themselves a favour and get this [NCT], either with their GP or at Croí,” Ní Fhlatharta concluded, noting that the advantage at Croí is a “holistic approach” to advice on individual programmes, and time to talk – a luxury that many hard-pressed GPs don’t enjoy.
Croí takes assessments for programmes through GP referral, but people can make contact directly by tel 091-544310. croi.ie
