A Guide to Exercise for Congestive Heart Failure Patients

James R. Clark, MD, with Carl Sherman

Series Editor: Nicholas A. DiNubile, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 8 - AUGUST 98

For many years, patients who had congestive heart failure (CHF) were advised to avoid physical activity. Now we know that most CHF patients have much to gain from exercise, at little risk.

Benefits. Along with prescribed medication, regular exercise will help relieve symptoms like shortness of breath and weakness. It will enable you to walk farther, work or shop with less fatigue, and enjoy leisure activities longer. Exercise will help prevent or limit other health problems like coronary heart disease, diabetes, high blood pressure, and high cholesterol.

General guidelines. Before you start an exercise program, your doctor will prescribe medication to control your CHF as well as possible. He or she may also give you a "stress test" to see how your body responds to exercise and determine a safe, effective level of exercise.

The best exercises for CHF are aerobic activities, like walking or biking vigorously enough to raise your pulse and work up a sweat. But start slowly, especially if you have been inactive.

The first step is often interval training, in which you exercise for a few minutes and then rest. This alternating pattern gives you the benefits of exercise without undue strain. Gradually you can increase the time and pace as you grow stronger. Ideally, you will eventually exercise for 30 to 40 minutes three to five times a week.

A Sample Schedule

Your doctor may suggest a workout schedule designed for you, but here is a sample program.

Start with walking or stationary biking for 2 minutes at a comfortable pace. Rest for 1 minute. Repeat this five times, until you have exercised for a total of 10 minutes.
Over 2 weeks, gradually increase the exercise period to about 4 minutes and the rest period to 2 minutes, until your total exercise time is about 20 minutes per session.
As you become stronger, increase the exercise intervals to 5 minutes and keep the rest intervals at 2 minutes, until your total exercise time is 30 minutes per session. You can also step up your pace.
Gradually increase the sessions to 40 minutes. You may keep or eliminate the rest stops.
Vary your program. If you walk for exercise 1 month, for example, try a stationary bike the next. This makes workouts more interesting.

Other exercises. Your doctor may also prescribe exercises to strengthen muscles. These may include:

Respiratory muscle exercises to build up your chest, diaphragm, and abdominal muscles to help you breathe better.
Resistance training that uses light weights to strengthen muscle groups in your arms, torso, and legs. Stronger muscles will reduce fatigue.

Safety Tips

Done properly, exercise is extremely safe for CHF patients. Especially when you start, however, you should consult your doctor about how your body is responding. He or she can help you distinguish normal from abnormal responses. A little increase in leg swelling and mild fatigue, for example, are normal during the first few weeks of exercise.

Other important tips:

Be alert for symptoms like chest pain, increasing shortness of breath, weight gain, ankle swelling, abdominal bloating, or rapid pulse at rest. Call your doctor, and stop exercising until the symptoms are controlled.
Exercise and medication usually work well together. However, if you work out shortly after taking your medication, you may become dizzy or faint. A change in timing of exercise will often relieve the problem. Also, avoid exercise right after meals.
Warm up. Before exerting yourself, spend 10 minutes in slow, easy activity—walking slowly and stretching—to increase blood flow to your muscles.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Clark is medical director of Medical Fitness in Charlottesville, Virginia. Mr Sherman is a freelance writer in New York City. Dr DiNubile is an orthopedic surgeon in private practice in Havertown, Pennsylvania.

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