Ask A Doc Shoveling

November 22, 2016

Dr. Arun Nagpaul
Rochester Regional Health

Dear Doc, After the last snow storm my stubborn father, who has a history of heart disease, was insistent on shoveling his driveway.  I was able to convince him to let the grandkids do it.  Can you tell us if it is safe for someone with heart disease to shovel snow?

Those beautiful 6 sided snowflakes that are made up of 180 billion molecules of water permanently cover around 12 % of the Earth's land. The continental United States averages 105 snow producing storms each year.

According to the Weather Channel, America's snowiest major cities with their snowfall average in inches per year include:

1. Syracuse, NY (126.3)
2. Erie, PA (100.8)
3. Rochester, NY  (100.1)
4. Buffalo, NY (96.1)
5. Anchorage, Ak  (75.6).  

So clearly your father's driveway will need to be shoveled many more times this upstate NY winter!

Anyone who has shoveled snow knows that it is a good aerobic exercise, burning up to 500 calories per hour. That is the equivalent of a high impact aerobics class or an hour long run! The average shovel loaded with 16 pounds of snow ends up moving 192 pounds of snow if you load your shovel 12 times a minute. In only 10 minutes you would have burned close to 85 calories and moved almost 2000 pounds of snow!!!

That amount of exercise can be a strain on anyone's heart.  In addition to your heart rate and blood pressure rising with the exercise, your body naturally constricts (narrows) its blood vessels in response to the cold, potentially decreasing the flow of blood to your heart. Death rates from heart attacks may triple among middle age men while shoveling snow.

The most common injuries that required treatment were soft tissue injuries (55%), lacerations (16%), and fractures (7%). The lower back was the most frequently injured region of the body. Straining, falls, and being hit by a snow shovel were the most frequent mechanisms of injury. 

Cardiac related injuries accounted for only 7 % of the total number of ER visits but were the most serious, accounting for more than half of the hospitalizations and 100% of the fatalities associated with shoveling snow.  It is estimated that more than 100 people die each year of heart attacks due to  shoveling snow !

Experts recommend talking to your doctor before you shovel, especially if you do not exercise on a regular basis, or have a history of heart disease.  It is suggested that if you have risk factors for heart disease such as smoking, high cholesterol or high blood pressure that you also discuss with your doctor before committing to clearing the drive way. After all, you wouldn't normally go from sitting on the couch to an exercise program that is the equivalent of running for an hour!!! 

If you are fit enough to shovel follow these 10 tips to shovel safely:

1. Warm up with light exercise before you start.
2. Avoid caffeine,  alcohol, and nicotine. Alcohol can make it difficult for people to tell how much they are straining themselves and may increase the chance of injury.  Caffeine and nicotine are stimulants and may increase heart rate.  Smoking also may decrease blood flow to the heart.
3. Avoid a heavy meal. After eating  your body shifts blood flow to the gut to help digest the food, leaving less oxygen carrying blood available for the heart.
4. Shovel early, shovel often and take breaks to lessen the strain on your body and heart.
5. Push, don't lift.  Pushing is less likely to strain muscles in your back.  If you have to lift the snow, use proper technique. Lift with your legs not your back. Bend your knees and keep your back as straight as possible so the power comes from your legs. Never bend at the waist.
6. Dress warmly in layers so you can remove a layer if needed.  Wear nonslip footwear.
7. Consider an ergonomically designed shovel to reduce injuries.
8 Do not work to exhaustion.  Your safety awareness lessens when you are fatigued.
9. Don't be afraid to ask for help.  Shoveling with someone may be safer and even more enjoyable.
10. Know the warning signs of a heart attack.  These may include chest pain, shoulder, neck or arm pain. Shortness of breath, dizziness and nausea may also be experienced during a heart attack.  If you think you are having a heart attack seek medical attention immediately by calling 911. 

And for those of you using a Snow Blower.  Please avoid a trip to the Emergency Room by: following these common sense tips.

1. If the blower jams, turn it off.
2. Keep your hands away from moving parts.
3. Avoid alcohol and nicotine (see above).
4. Be aware of carbon monoxide risk if running blower in an enclosed area.
5. Refuel your blower when it is off, never while it is running. 

So, I hope your "stubborn" father is appreciative of his son's advice and those snow shoveling grandkids! Enjoy the snow, shovel safe, and remember the quote from Susan Orlean, "One of the very best reasons for having children is to be reminded of the incomparable joys of a snow day."

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