Heart Disease: Exercise for a Healthy Heart

A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it's a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system.
• Improve your circulation and help your body use oxygen better.
• Improve your symptoms of congestive heart failure.
• Increase energy levels so you can do more activities without becoming tired or short of breath.
• Increase endurance.
• Lower blood pressure.
• Improve muscle tone and strength.
• Improve balance and joint flexibility.
• Strengthen bones.
• Help reduce body fat and help you reach a healthy weight.
• Help reduce stress, tension, anxiety, and depression.
• Boost self-image and self-esteem.
• Improve sleep.
• Make you feel more relaxed and rested.
• Make you look fit and feel healthy.

How Do I Get Started?

Always check with your doctor first before starting an exercise program. Your doctor can help you find a program that matches your level of fitness and physical condition. Here are some questions to ask:

• How much exercise can I do each day?
• How often can I exercise each week?
• What type of exercise should I do?
• What type of activities should I avoid?
• Should I take my medication(s) at a certain time around my exercise schedule?
• Do I have to take my pulse while exercising?

What Type of Exercise Is Best?

Exercise can be divided into two basic types:

• Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing (since your heart won't have to work as hard during exercise).
• Strengthening exercises are repeated muscle contractions (tightening).

What Are Examples of Aerobic Exercises?

Aerobic exercises include: walking, jogging, jumping rope, bicycling, skiing, skating, rowing, and aerobics.

How Often Should I Exercise?

In general, to achieve maximum benefits, you should gradually work up to an aerobic session of at least  20 to 30 minutes, at least three to four times a week. Exercising every other day will help you start a regular aerobic exercise schedule. The American Heart Association recommends working up to exercising on most days of the week. While the more exercise you can do the better, any amount of exercise is beneficial to your health.

What Should I Include in My Program?

Every exercise session should include a warm-up, conditioning phase and a cool-down.

• Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature. It also helps improve flexibility and reduce muscle soreness. The best warm-up includes dynamic stretching (as compared to the “touch your toes” stretches you did in high school) and the beginning of the activity at a low intensity level.
• Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms.
• Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.

What Is the Rated Perceived Exertion Scale?

The Rated Perceived Exertion (RPE) scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) would be how you feel at the end of an exercise stress test or after a very difficult activity.

Rated Perceived Exertion (RPE) scale
0	Nothing at all
0.5	Just noticeable
1	Very light
2	Light
3	Moderate
4	Somewhat heavy
5-6	Heavy
7-9	Very heavy
10	Very, very heavy

When starting an exercise program, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

Exercise while sitting

While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.

• Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
• Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
• Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
• Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
• Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
• Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
• Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
• Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
• Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

How Can I Avoid Overdoing It?

Here are a few guidelines:

• Gradually increase your activity level, especially if you have not been exercising regularly.
• Wait at least one hour after eating a meal before exercising.
• When drinking liquids during exercise, remember to consider any fluid restriction guidelines.
• Exercise at a steady pace. Keep a pace that allows you to talk during the activity.
• Keep an exercise record.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Here are some questions you can think about before choosing a routine:
• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
• Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

General Workout Tips for People With Heart Failure

• Be sure any exercise is paced and balanced with rest.
• Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
• Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
• Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
• If your exercise program has been interrupted for more than a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Exercise Precautions

There are many precautions you must keep in mind when developing an exercise program. Here are some tips.

• Stop the exercise if you become overly fatigued or develop chest pain or shortness of breath; discuss the symptoms with your doctor or schedule an appointment for evaluation.
• Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
• If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
• Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it's still above 120 beats per minute, call the doctor for further instructions.

If you experience pain:

• Don't ignore it. If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints.

Warning

Stop exercising and call your doctor if you have any of the following symptoms:

• Chest pain
• Weakness
• Dizziness or lightheadedness
• Unexplained weight gain or swelling
• Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern.