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Is exercise that’s too intensive resulting in your angina?

Navy Hospitalman Kiana Bartonsmith checks a patient’s heart rate at Naval Branch Health Clinic Kings Bay in Georgia, one of Naval Hospital Jacksonville’s six health care facilities. (U.S. Navy photo by Jacob Sippel) Navy Hospitalman Kiana Bartonsmith checks a patient’s heart rate at Naval Branch Health Clinic Kings Bay in Georgia, one of Naval Hospital Jacksonville’s six health care facilities. (U.S. Navy photo by Jacob Sippel)

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Conditions and Treatments | Health Readiness | Heart Health | Preventive Health

Coronary artery disease is the most common type of heart disease and the leading cause of death in the United States for both men and women. Arteries carry oxygenated blood throughout the body including to the heart muscle. Over time, plaque can build up in the arteries, which harden and constrict blood flow to the heart. When the heart does not get enough blood, the body’s response is angina. Angina is experienced as a feeling of tightness or pressure in the chest that can also radiate out to the neck, jaw, back, or shoulders. Women may also experience nausea, shortness of breath, or fatigue. Angina can be exercise-induced or caused by other symptoms of heart disease.

“Any time the heart’s demand for oxygen is greater than the supply, there is a chance for angina,” said Dr. Jamalah Munir, a cardiologist at Fort Belvoir Community Hospital. “Angina most commonly occurs during physical exertion, such as walking quickly up a hill or flights of stairs.” Increases in blood pressure or stress, abnormally fast heart rhythms, severe illness, or anemia can also raise the risk of experiencing angina, she added.

Preventing coronary artery disease is the goal, Munir said. This means eating a whole-food, plant based diet with minimal animal products, as well as exercising regularly, sleeping well, reducing stress, and refraining from smoking.

Even with these preventive measures, exercise can induce angina even in presumably healthy individuals. “When you exercise, your heart needs more oxygen and nutrients,” said Munir. “If the demand outstrips the supply, the result is angina.”

Someone with angina would experience a dull sensation rather than a sharp pain, which typically comes on gradually during exercise and can improve with rest, she added. Nitroglycerin, a medication that relaxes the arteries and increases blood flow, can alleviate chest tightness and pressure.

“Should you experience persistent angina while at rest or at lower levels of activity, seek medical care immediately for a possible heart attack,” Munir cautioned.

The temptation might be to think that if exercise induces angina, the safest course of action would be to remain on the couch. Munir disagrees, stating that when it comes to daily exercise, it doesn’t have to be intense or done all at once. “Some people complain that they can’t make it to the gym for a full workout, but if they walk for 10 minutes after each meal, that adds up to 30 minutes a day.” Moderate exercise combined with strength training, stretching, meditation, or yoga practice is all important to cardiovascular health, she added.

A physician can test for indicators of coronary artery disease – high blood pressure, abnormal heart rhythm, or high cholesterol – that contribute to angina. Medications can stabilize or reduce these symptoms when combined with other healthy habits such as regular exercise.

“If the combination of medication and lifestyle changes isn’t effective, invasive procedures such as coronary stents and open heart bypass surgery are options to consider,” said Munir.

To protect health, especially the heart, “dietary and lifestyle modification are the cornerstone of prevention and treatment of coronary artery disease,” she added. “Incorporating small changes into your lifestyle can make a big difference.”

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Five cold seasons: July 2012-June 2017, Active reserve component service members who were diagnosed with a cold weather injury

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Did you know during the 5-year surveillance period, the 2,717 service members who were affected by any cold weather injury included 2,307 from the active component and 410 from the reserve component. Overall, Army members comprised the majority (61.6%) of all cold injuries affecting active and reserve component service members. Of all affected reserve component members, 71.7% (n=294) were members of the Army. Cold weather injuries During Basic Training Of all active component service members who were diagnosed with a cold weather injury (n= 2,307), 230 (10.0% of the total) were affected during basic training. Additionally, during the surveillance period, 60 service members who were diagnosed with cold weather injuries during basic training (2.6% of the total) were hospitalized, and most (93.3%) of the hospitalized cases were members of either the Army (n=32) or Marine Corps (n=24). Cold weather injuries during basic training pie chart: The Army (n=122) and Marine Corps (n=99) comprised 96.1% of all basic trainees who were diagnosed with a cold weather injury. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness Image of service member tracking in the snow is the infographic background graphic.

This infographic provides information on active and reserve component service members who were affected by any cold weather injury during the July 2012 – June 2017 cold seasons.

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Update: Cold Weather Injuries, Active and reserve components, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
The total number of cold weather injuries among active component service members in 2016 – 2017 cold season was the lowest since 1999. 2016 – 2017 versus the previous four cold seasons  •	A total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold weather injury. •	Rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. •	Cold weather injuries associated with overseas deployments have fallen precipitously in the past three cold seasons due to changes in military operations in Iraq and Afghanistan. There were just 10 cases in the 2016 – 2017 season.  •	Frostbite was the most common type of cold weather injury. Bar chart displays numbers of service members who had a cold injury (one per person per year), by service and cold season, active and reserve components, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Cold weather injuries by military location, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
From July 2016 through June 2017, a total of 24 military locations had at least 30 incident cold weather injuries (one per person, per year) among active and reserve component service members.  The locations with the highest 5-year counts of incident injuries were: •	Fort Wainwright, AK (175) •	Bavaria (Grafenwoehr/Vilseck), Germany (110) •	Marine Corps Recruit Depot Parris Island/ Beaufort, SC (102) •	Fort Benning, GA (99) •	Fort Carson, CO (88) •	Marine Corps Base Quantico, VA (86) •	Fort Bragg, NC (78) Map displays the information above. 2016 – 2017 cold season During the 2016 – 2017 cold season, the numbers of incident cases of cold weather injuries were higher than the counts for the previous 2015-2016 cold season at seven of the 24 locations. The most noteworthy increase was found at the Army’s Fort Wainwright, where there were 48 total cases diagnosed in 2016 – 2017 , compared to just 16 during the 2015 – 2016 cold season. Bar chart shows annual number of cold weather injuries (cold season 2016 – 2017) and median number of cold weather injuries (cold seasons 2012 – 2016) at military locations with at least 30 cold weather injuries during the surveillance period, active component, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR Image in background includes  service members out in the snow.

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Incidence rates of cold weather injuries: Non-Hispanic black service members, five cold weather seasons, July 2012 – June 2017

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Did you know for all of the services, overall rates of cold weather injuries were higher among non-Hispanic black service members than among those of other race/ethnicity groups? •	Rates of cold weather injuries among non-Hispanic black service members were two-times as high as those among non-Hispanic white or other race/ethnicity groups.  •	The rates of frostbite among non-Hispanic black service members were three-times those of the other race/ethnicity groups. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to www.Health.mil/MSMR  #ColdReadiness Image of non-Hispanic black service member in the snow displays.

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Cold weather injuries during deployments, July 2012 – June 2017

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1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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2016 – 2017 Cold Season, Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces

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or the 2016 – 2017 cold season, the number of active component service members with cold weather injuries was the lowest of the last 18 cold seasons since the Medical Surveillance Monthly Report (MSMR) began reporting such data in the 1999-2000 cold season. Findings •	The overall incidence rate for cold weather injuries for all active component service members in 2016 – 2017 was 15% lower than the rate for the 2015 – 2016 cold season. •	The 2016 – 2017 rate was the lowest of the entire five year surveillance period. •	In the 2016 – 2017 cold season, the Army’s incidence rate of 41.0 per 100,000 person-years for active component soldiers was 18% lower than the Army’s lowest previous rate in 2012 – 2013. •	In the Navy, Air Force, and Marine Corps, the active component rate for 2016 – 2017 was only slightly higher than their lowest rates during the 2012—2017 surveillance period. Pie chart 1 (left side of infographic): Cold Weather Injuries, By Service, Active Component, 2016 – 2017 data •	Army 57.6% (n=189) •	Marine Corps 21.0% (n=69) •	Air Force - 13.1% (n=43) •	Navy – 8.2% (n=27) •	The sharp decline in the Army rate during the 2016 – 2017 cold season drove the overall decline for all services combined. Pie chart 2 (right side of infographic): Percentage distribution by service of cold weather injuries among reserve component service members during cold season 2016 – 2017  •	Army 72.9% (n=43) •	Marine Corps 13.5% (n=8) •	Air Force 13.5% (n=8) •	Navy (n= 0) •	For the 2016 – 2017 cold season, the overall rate of cold weather injuries for the reserve component and the rates for each of the services except the Air Force were lower than in any of the previous four seasons. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR

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Percentages of each Service’s cold weather injuries, 2016 – 2017 cold season

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Did you know when all cold weather injuries were considered, not just the numbers of individuals affected, frostbite was the most common type of cold weather injury, comprising 53% (n=177) of all cold weather injuries among active component service members in 2016 – 2017? •	In the Air Force and Army respectively, 60.9% and 58.9% of all cold weather injuries were frostbite, whereas the proportions in the Marine Corps (42.9%) and Navy (25.0%) were much lower. •	For the Navy, the 2016-2017 number and rate of frostbite injuries in active component service members were the lowest of the past 5 years. •	The number of immersion injury cases in 2016 – 2017 in the Marine Corps was the lowest of the 5-year surveillance period. Bar graph: Percentages of each Service’s cold weather injuries that were frostbite, 2016 – 2017 cold season •	Air Force (60.9%) •	Army (58.9%) •	Marine Corps (42.9%) •	Navy (25.0%) For all active component service members during the 2016 – 2017, the proportions of non-frostbite cold weather injuries were as follows: •	19.5% hypothermia •	17.7% immersion injuries •	9.9% Other & unspecified cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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5/25/2017
This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016. LONG FORM: In 2016, the three burden of disease related conditions accounted for the most medical encounters were: •	Other back problems •	All other musculoskeletal diseases •	Knee injuries Altogether they accounted for 25.1% of all illness-and injury-related medical encounters overall. More Findings The top nine conditions that accounted for the most medical encounters accounted for 53.1% of all illness-and-injury –related medical encounters overall. In general, the conditions that accounted for the most medical encounters were predominantly musculoskeletal disorders such as the back) injuries to the knee, arm, shoulder, foot or ankle, and mental disorders like anxiety and adjustment conditions. View more findings at www.Health.mil/MSMR    Graphic details This graphic displays the musculoskeletal of a male service member’s body to show the bones of the back and knees.

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