gt;If you have chronic obstructive pulmonary disease (COPD), you're at an increased risk for developing other health problems, such as gt;osteoporosisgt;, gt;gastroesophageal reflux disease (GERD)gt; , gt;diabetesgt;, and gt;heart diseasegt;. But there are certain times when COPD patients are more vulnerable to heart attack or strokes than other people: in the days and weeks after an exacerbation, a serious flare-up in symptoms, which can land you in the hospital.gt;gt;gt;Exacerbationsgt; are often a fact of life if you have severe COPD, according to Byron Thomashow, MD, clinical professor of medicine at Columbia University, medical director of the Jo-Ann F. LeBuhn Center for Chest Disease at NewYork-Presbyterian Hospital, and chairman of the board of the COPD Foundation. Whether it's air pollution, a cold, or another lung infection that sets them off, exacerbations can ramp up your shortness of breath or cough to dangerous levels.gt;gt;"I think about three-quarters of patients have at least one a year," he says. "Even in those people who successfully get through an exacerbation … it can take months and months to get back to their prior level of quality of life and function even though the symptoms go away quickly."gt;gt;In general, people with more exacerbations tend to have poor lung function, reduced activity, increased inflammation, and higher mortality rates.gt;gt;gt;What causes exacerbationsgt;gt;The flare-ups are typically caused by infections from a virus or bacteria (particularly for smokers, who are at an increased risk of getting infected). Medications to treat COPD, including inhaled steroids like Advair, can also increase the risk of pneumonia, which can result in exacerbations. The risks have to be weighed with the potential benefits, and not using medication correctly can itself result in exacerbations.gt;gt;In about one-third of flare-ups, there is no obvious cause, says William Barkman, MD, MSPH, a gt;pulmonologistgt; and chief of staff at the University of Kansas Hospital, in Kansas City, Kan. gt;gt;"It could be environmental, or sometimes people stop taking their medications, which can lead to an exacerbation. And occasionally a comorbid disease like heart failure is the cause," Dr. Barkman adds.gt;gt;To reduce the risk of problems related to COPD exacerbations, patients are typically treated with oxygen, medication, including beta agonists and antibiotics, and sometimes steroids to reduce inflammation. gt;gt;gt;gt;How does COPD affect heart health?gt;gt;All COPD patients are at risk for heart problems—about 30% of people with COPD die of cardiovascular disease. And those who have exacerbations are more likely to have heart problems following a flare-up. gt;gt;Patients who had exacerbations had a 2.27-fold greater risk of a heart attack one to five days after the flare-up, according to a 2009 study in the journal Chest. They had a 1.26-fold greater risk of stroke between one and 49 days after an exacerbation. gt;gt;A 2006 article in Thorax found that COPD patients with high levels of C-reactive protein (a protein in the blood that rises in response to inflammation) have increased relative risk of mortality, and were 1.85 and 1.51 more likely to die of cancer and cardiovascular events, respectively, than COPD patients with low levels of C-reactive protein. gt;gt;It is estimated that there's one shared risk factor for both COPD and cardiac events: smoking. Another likely cause is the chronic inflammation that occurs with COPD, which damages blood vessels. This inflammation becomes acute during a flare-up. gt;gt;gt;Do medications play a role?gt;gt;Medications given during the events, like inhaled beta agonists (gt;Albuterolgt;), can also negatively affect the heart. gt;gt;Robert Ostfeld, MD, MSC, a cardiologist and associate professor of clinical medicine at Montefiore Medical Center in Bronx, N.Y., says the beta agonists can increase the heart rate, forcing it to work harder; promote arrhythmia, or irregular heart rate; and increase blood pressure. gt;gt;There is no guaranteed way to completely avoid exacerbations, but there are many things you can do to help prevent them and thereby reduce the risk of heart attacks triggered by exacerbations, Dr. Thomashow says. gt;gt;Using long-acting gt;bronchodilatorsgt;, such as gt;salmeterolgt;, in combination with gt;inhaled corticosteroidsgt;, like Flovent and Azmacort, and anticholinergics, which relax and open up airways, such as Spiriva, can reduce exacerbations. Dr. Thomashow says taking the three in combination can also decrease heart attack risk by 60% or more, probably because they reduce exacerbation risk.gt;gt;In addition, people can also take some very basic actions to help prevent respiratory infections, which can cause exacerbations. Dr. Ostfeld recommends regular hand washing and not touching your face in public places (which can spread germs from hand to mouth before you can wash them). And remember to get your flu shots, to prevent respiratory ailments, too.gt;gt;And finally, he encourages COPD patients to exercise regularly, eat a largely plant-based diet, and have regular checkups to make sure things like blood pressure and cholesterol are under control.gt;gt;"Having a healthy lifestyle and keeping underlying medical conditions well treated will go a long way to protecting yourself from any medical problems," Dr. Ostfeld says.gt;gt;

For Marika Holmgren, fighting breast cancer was an uphill battle—literally. She got back on her mountain bike shortly after her diagnosis in February 2007, smack-dab in the middle of chemotherapy.gt;gt;"The treatment is so intense—it actually strips everything away. You’re physically and completely changed," says Holmgren, 40. "I was trying to retain some sense of normalcy. And truthfully, I felt a little badass being on my bike during treatment. I was giving cancer the middle finger."gt;gt;Tooling around on a mountain bike during chemotherapy sounds intense, maybe even unadvisable. But just the opposite is true: Holmgren was being a model patient.gt;gt;In the past, doctors often told cancer patients to take it easy during treatment. Although the appropriate amount of exercise varies from patient to patient, that conventional wisdom is now considered old hat. In fact, new guidelines on cancer and exercise from the American College of Sports Medicine (ACSM) urge cancer patients to be as physically active as possible both during and after their treatment. gt;gt;gt;"The idea that you should be staying put and resting is ultimately doing more harm than good," says Kathryn Schmitz, PhD, an epidemiologist at the University of Pennsylvania School of Medicine, in Philadelphia, who studies the role of physical activity in chronic diseases. Schmitz presented the guidelines at the American Society of Clinical Oncology’s annual meeting last week.gt;gt;It’s true that the last thing people overwhelmed by cancer’s psychological and physical impact may want to hear is "exercise more." During treatment, bone-crushing fatigue, nausea, and body-changing surgery, not to mention the emotional drain of coping with worried children, friends, and life partners, often puts exercise very last on the list of priorities.gt;gt;Still, experts now say that exercise may help with—not add to—those problems. It boosts energy, helps stave off the weight gain often associated with treatment, and provides a psychological pick-me-up at a time when a person’s morale is likely to be battered. gt;gt;gt;gt;Even small amounts helpgt;gt;How much exercise is enough? The ACSM recommends 150 minutes of moderate-intensity aerobic exercise per week, which works out to about 20 minutes a day—the same amount recommended to the general public. gt;gt;But that said, the organization is realistic about how cancer and its treatment can alter mood and energy levels. Any kind of activity—even a short walk—is better than none, ACSM says.gt;gt;"The risk of inactivity for cancer patients is so great that it’s best to just get started with something," says Schmitz. If you begin to feel worse or overtired, Schmitz recommends discussing it with your doctor.gt;gt;People who were sedentary before their diagnosis should commence by walking for 10 minutes each day, says Schmitz, and gradually increase their time by 10% to 15% each week until they can do 30 minutes at a stretch, five times per week.gt;gt; There may be days when you feel nauseous, exhausted, or utterly despondent. But friends or family can help. "A lot of it will be up to the caregivers because they are the ones who will know how to motivate patients facing an uphill battle," says Schmitz. "They’re the ones who can say, ‘Hey, let’s get dressed today,’ and then, ‘Hey, let’s get dressed and walk around the house.’ "gt;gt;It’s important to pick an activity you enjoy, says Alyson Moadel, PhD, the director of the psychosocial oncology program at the Albert Einstein Cancer Center, in the Bronx, N.Y. "It is not a one-size-fits-all answer, since patients may be more responsive and adherent to different fitness programs," she says. "It’s important to allow patients a choice and to tailor a fitness program to each patient."gt;gt;Fortunately the options are greater than ever before, as exercise programs for cancer patients have become increasingly popular nationwide. In 2007 the Lance Armstrong Foundation partnered with the YMCA to provide physical activities designed specifically for survivors, and more and more hospitals are creating their own programs as well. Cancer patients who aren’t willing or able to travel to a facility on a regular basis can sign up for programs that can be delivered by mail, phone, or the Internet. gt;gt;"Right now we’re working to develop a variety in the types of programs available," says Schmitz.gt;gt;Holmgren—a longtime mountain biker—took to the San Francisco hills with a group of women who ride with the Bay Area chapter of gt;Team LUNA Chixgt;, a program that brings together amateur bikers, runners, and triathletes, and is affiliated with the Breast Cancer Fund, a nonprofit advocacy organization based in San Francisco. gt;gt;"I had no hair, no eyelashes, and no eyebrows, and yet I didn’t think they would know I had cancer," says Holmgren. "The women were so fun and inspiring, and they never babied me. They just let me do my thing at my own pace."gt;gt;gt;gt;How exercise helpsgt;gt;Dozens of studies have demonstrated the benefits of staying active both during and after treatment. gt;gt;Regular exercise can help fight the weight gain that often comes with cancer treatment, including breast cancer. "It’s about what the typical American could expect to gain over the course of a couple of years, but it’s happening all at once," says Schmitz.gt;gt;But exercise is also important for cancer patients whose treatment can cause them to lose weight. Prostate cancer, cancers of the stomach and gut, and head and neck cancers can all lead to a significant decrease in muscle mass, as well as a loss of taste and an inability to process certain foods.gt;gt; "Those patients really need to focus on resistance exercises," says Schmitz. "That will help them increase their muscle mass and gain that functional tissue that they need."gt;gt;Even though most patients won’t be able to accomplish the same physical feats they were capable of before their diagnoses, adds Schmitz, staying active helps them achieve "a whole lot more than they would have been able to if they hadn’t been exercising."gt;gt;Exercising has more intangible benefits as well. In a 2007 study that followed advanced cancer patients who exercised while undergoing chemo, the participants were asked to keep diaries. Many of them noted the positive mental aspects of exercise. "It feels good to have a sense of an everyday life again," wrote one participant. "I have become incredibly energetic," wrote another.gt;gt;In addition to making patients feel normal again, staying active is a way for patients to measure the progress of their recovery. Holmgren stuck with her rides all summer while she was undergoing chemo. "They became a real benchmark for me," she says. "The more I would ride, the more I felt like I was getting back to my old self."gt;gt;Though Holmgren still can’t handle some of the climbs she conquered pre-diagnosis, mountain biking has helped her make peace with her changed body.gt;gt;"The hormone treatment, early menopause, early arthritis, the weight gain, the surgeries—breast cancer takes a huge toll on your body," she says. "I knew I was going to feel bad no matter what, so I figured I might as well be feeling bad on my bike doing something that I used to do—and something that people not going through cancer might not be able to do."