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[EXERCISE ADVISER]

Exercise for Heart Patients: Optimal Options

Barry A. Franklin, PhD with James R. Wappes

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 10 - OCTOBER 98


Exercise is vital if you've had a heart attack, balloon angioplasty, or bypass surgery, or if you are affected by heart disease in some other way, like having chest pain when you exert yourself. Of course, you also need to eat smart and take other healthy steps to reduce your risk of further problems (see "The Complete Heart-Care Package," below). Regular physical activity under your doctor's direction, though, is a key part of managing your disease.

Is exercise worth the effort? Absolutely. Heart patients who increase their physical activity also boost their confidence; increase their fitness level; cut their risk of dying; report less depression, stress, and social isolation; and improve their overall sense of well-being. Your doctor will recommend an exercise program specific to your condition, but most people who have heart disease can benefit from the suggestions below.

An Aerobic Foundation

One of the most important components of an exercise program for heart patients is aerobic exercise. Aerobic exercise involves using large muscle groups (like in your legs) rhythmically for prolonged periods, such as in walking, jogging, or biking.

Consistency is essential in aerobic workouts. You need to do aerobic exercise at least 30 minutes three times a week. But start with whatever you can comfortably do (see "Cardiac Warning Signs," below) and work up to this minimum. As your physical condition improves, consider gradually increasing your workouts to 30 to 60 minutes five or more times a week.

You can accumulate your 30-plus minutes of aerobic exercise in several 10- or 15-minute bouts. This approach might be especially helpful for busy people or those not used to exercising.

Before starting aerobic exercise, prepare your muscles and get your heart pumping gradually by doing light calisthenics or easy walking and stretching for 10 to 15 minutes. Ideally, the warm-up should raise your heart rate to within 20 beats per minute of the heart rate recommended for endurance training (see "Intensity" section below). After ending your workout, cool down by strolling and stretching for at least 5 minutes.

Options. Choosing an aerobic exercise depends on personal preferences and options available. Walking, though, is an excellent choice, especially for those who have been inactive or not very active. Start with good walking shoes and whatever distance you can do at a pace that makes you pleasantly tired. Add minutes gradually. In bad weather, try mall walking or exercising at a health club.

Variety in your workouts can help you stick with your exercise program. If you thoroughly enjoy walking, adding variety may simply mean changing your route from time to time or exercising with a friend.

Or you may want to try another type of exercise, like jogging, biking, swimming, or aerobics classes. Exercise machines like stationary bikes, cross-country ski machines, stair-climbing machines, treadmills, and rowing machines also provide good aerobic workouts, whether in your home or at a gym. Many exercise machines allow you to read, watch TV, or listen to music while working out.

Intensity. Work out at a level that feels fairly light to somewhat hard. You may be sweating and breathing hard, but not gasping for breath.

Your exercise heart rate should be 10 or more beats per minute below the level that triggers abnormal signs or symptoms (see "Cardiac Warning Signs," below). (Count your pulse [figure 1] for 10 seconds and multiply by six to get your heart rate in beats per minute.) Your doctor should recommend an exercise heart rate that is considered safe and appropriate for you. This may involve taking an exercise stress test to determine your peak heart rate.

[Figure 1]

Is it risky? Some people worry about having a heart attack while exercising. It's true that your risk is a bit higher during a workout than while resting. But you can minimize the risk by listening to your exercising body and stopping when you experience signs of a heart problem (see "Cardiac Warning Signs," below). The bottom line: Inactive people are at a higher overall risk of a heart attack than those who are active.

Strength Exercises

It may also help heart patients to include strength training—also called weight lifting or resistance training—in their physical conditioning program. In addition to increasing your muscle fitness and well-being, strength training can reduce the heart-rate and blood-pressure responses to upper-body work such as lifting. Thus, resistance training can decrease the demands on your heart during work and leisure-time activities.

Heavy loads, however, can place undue stress on the heart, so use light loads that permit a lot of repetitions (ideally do 10 to 15) per set. Strength training should work all the major muscle groups in your body. Single-set programs done two to three times a week are recommended over multiple-set programs because they are highly effective and less time-consuming.

Flexibility Options

The American College of Sports Medicine recommends that flexibility exercises (stretching) round out any exercise program. Stretching can be included as a warm-up and cool-down in your aerobic exercise routine as discussed above, done as a separate workout two to three times a week, or both. Ask your doctor or other healthcare provider for exercises that stretch all the major muscle groups.

Daily Heart Boost

In addition to a specific exercise program, you can help your heart further by increasing your activity in daily life. For example, ride a stationary bicycle while watching TV or reading the newspaper. Take up gardening, switch to a manual lawn mower, or walk or bike on short errands. Maybe you could park a mile from work and walk, park your car at the farthest end of parking lots, take the stairs instead of the elevator, and walk the dog more often. Use your imagination!


Cardiac Warning Signs

You need to stop exercising immediately and consult a doctor if you have:
  • Pain or pressure anywhere from you neck to your navel,
  • Dizziness,
  • An abnormal heart rhythm,
  • Unusual shortness of breath, or
  • Nausea.


The Complete Heart-Care Package

In addition to exercising, heart patients can take several steps to reduce the risk of further heart problems:

Choose low-fat, low-cholesterol, low-calorie, and nonfat food items, and eat plenty of grains, fruits, and vegetables. Aim for a low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) level under 100 milligrams per deciliter.

  • Quit smoking.
  • Take the medications your doctor has prescribed.
  • Learn to respond calmly to stressful situations. Develop stress-reducing techniques like deep breathing or meditation.
  • Lower your blood pressure if it is high (140/90 or higher). This typically involves diet, exercise, and sometimes medication.
  • Get regular checkups.
  • Consider joining a cardiac rehabilitation program, which provides guided exercise and social support.


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

Dr Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan. He is also a professor of physiology at Wayne State University School of Medicine in Detroit, president-elect of the American College of Sports Medicine, and an editorial board member of The Physician and Sportsmedicine. James Wappes is the assistant managing editor of The Physician and Sportsmedicine.


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