Why exercise?

Aerobic exercise is a proven way to improve life expectancy and reduce hospital admissions in heart failure patients. Regular exercise strengthens muscles and keeps them flexible, helping you maintain your mobility. Not only does exercise improve your ability to perform usual physical tasks, it can also help to control weight and improve your sense of well being.

Aerobic exercise should last for at least 30+ minutes, make use of large muscles groups and increase the heart rate, without a large increase in blood pressure. Examples of aerobic exercise include walking, swimming, bicycling and light aerobics.

Cardiac patients should avoid weight training, running and sports like squash and tennis without first getting medical advice. Gym and aerobics classes should only be done with an instructor who is trained for heart patients.


Before you start

If you are over 45 years of age, you should only start an exercise program after consultation with your doctor. It is recommended that cardiac patients undergo an ECG stress test to determine a safe work rate. Target work rates are often measured in heart beats per minute (bpm). This can be done by taking the pulse at the carotid artery in the neck, shown right, and counting the number of beats in 15 seconds, then multiplying this by four. Alternatively, patients can use a heart rate monitor, worn around the chest, with a read out given on a wrist watch. This has the advantage of the watch being able to tell you if you are exceeding your target heart rate.

For younger people training should be at about 80% of maximum heart rate, with older or sick patients working at 70% maximum. The maximum heart rate is approximately 220 minus their age in years (eg. 50 year old maximum heart rate = 220 – 50 = 170 bpm, target heart rate = 70% of 170 = 119 bpm). Another simple measure of work rate is the ‘talk test’. Quite simply, if you can talk with ease while exercising, then you probably need to work at a higher rate.


Planning your program

Try working the following into your program:

  • Always start at a slow and easy intensity.
  • Build up exercise duration over weeks and months (see the six week program below as an example).
  • Keep your basic heart rate at about 60% maximum.
  • Use 30 second periods of increased activity every 5-10 minutes (up to 70% maximum pulse rate).
  • Exercise at least three times a week, walking a total of 140 minutes or jogging 90 minutes every week.

You will be more motivated to continue exercising if you keep your program interesting.

  • Make it into a habit. Exercise with a friends and family or walk the dog.
  • Greet the people (and dogs!) along the route.
  • Vary the type of exercise you do.
  • Choose alternative routes. Keep it interesting!
  • Listen to music during stretching or as you walk.
  • Join a walking group with people at your level.


Safety tips

There are a number of things you can do to reduce the chance of injury or accident while exercising:

  • Limber up and stretch before and after each session (see below).
  • Use quality, well fitting shoes for both walking and jogging.
  • Exercise in the cool of the day in light coloured, loose cotton clothes. Wear reflectors on clothing and shoes if travelling near roads, especially at dawn or dusk.
  • Exercise with others for company, motivation and in case of accident. However, DON’T compete with them.
  • Plan your exercise route with an eye to the road rules. Try to use verges, footpaths or formed tracks.
  • Travel a circular course, if on foot or bicycle, to ensure that they do not overdo the distance by going too far in one direction, and to ensure that they do not get caught in a head wind on the way back.
  • Avoid exercising after having a meal or alcohol.
  • Do not exercise if feeling unwell or if you have influenza-like symptoms. If you feel dizzy or chest discomfort, STOP, and report to your doctor.
  • If you’re on GTN, always carry the spray with you.
  • If possible, carry on you identification, medical and drug information, small change for cab or bus fare (in case of necessity) and a mobile phone.


Measure your improvements

An important part of an exercise programme is being able to measure improvements in fitness. A simple test of aerobic fitness is the Cooper circuit. Quite simply, it is the distance that you can run or walk in 12 minutes. In cardiac patients it is recommended that they only walk this, which has been shown to be quite safe and an accurate estimation of aerobic ability. It can be performed at your own convenience as all it needs is a circuit of known distance that you can run around (eg. a running track, boundary line of a sporting field, etc). This gives a fairly accurate picture of your current fitness and can be used to compare performances over time. Test yourself before starting the program, and then at regular intervals from then on. The improvements you see will help to motivate you to continue.

 


Improve your whole lifestyle

Regular exercise isn’t the only component to a healthy lifestyle. To gain maximum benefits from your exercise program, also do the following:

  • Do not smoke.
  • Use a low fat, low cholesterol diet
  • Ask your General Practitioner to ensure your blood cholesterol and blood pressure are both normal.


Six week starter program

  • Exercise programs are most enjoyable if you choose to do activities that you enjoy. The following is based on swimming and a choice of land based activities (eg walking, cycling, tennis, dancing or a mixture of these).
  • You should perform stretching and limbering up exercises in the two weeks before starting this program, as well as for 5 minutes before and after each exercise session. This helps strengthen joints and tendons, especially after periods of inactivity.
  • Aim to complete at least three exercise sessions per week.
  • Exercise at a heart rate of 60% maximum with 30 second bursts at about 70% maximum, once every 5-10 minutes.
  • Slow down if you become short of breath, get chest pain, chest discomfort, palpitations or become excessively tired.
  • If there is excessive tiredness after exercise, slow down on the subsequent program by about one week.
Advice about aerobic exercise


Limbering up

Perform these movements slowly and rhythmically before and after exercise:

  • Rotate your neck 3 times clockwise and anticlockwise
  • Rotate your shoulders 6 times clockwise and anticlockwise
  • Lift your knees up to waist level 6 times for each leg
  • Go up and down on your toes 6 times
  • Rotate hips 3 times clockwise and anticlockwise
  • Step up onto a low stool with alternating legs 10 times.


Stretching

  • Slowly get into the position shown (don’t swing limbs or ‘bounce’) and gently feel the muscles stretch, for 6 seconds, then relax.
  • Repeat each stretch 2-3 times.
  • With improvement in flexibility, extend the stretch further, holding it for longer until you reach the time shown.
  • Always keep your back straight when stretching.
  • If pain occurs during stretching, STOP and consult your doctor.
  • Some muscle tightness will be felt the day after stretching. If this is more than mild, reduce the degree of stretching for a few days, and build up again.
Advice about aerobic exercise
  1. Gastrocnemius (calf muscle): Turn the back foot slightly inwards & push hips forward
  2. Soleus (calf muscle): Place your back foot just behind the front foot and lower back knee.
  3. Front of Hip (back leg): Push hips forward. Start off with a low stool and increase the height as you improve.
  4. Hamstrings: Only lean forward until you feel a pull behind the thigh
  5. Groin: Lean sideways towards leg. Start low and increase the height as you improve
  6. Quads: Start easy and eventually touch heel to buttocks. Lean against a something for support if necessary.
  7. Triceps: Pull the elbow across and down.
  8. Chest Muscles: No special comments.
  9. Neck and back: Keep knees bent. Breathe in as you lift your head.
  10. Buttocks: Pull the knee to your chest while keeping the other leg straight. Only stretch until you can feel a pull at the hip.


A final word…

Remember that exercise is not just good for your heart, but for your whole body, including the mind. Build up slowly and include regular stretching in your exercise program. Don’t forget to regularly assess your progress by performing the Cooper circuit assessment and monitoring heart rate. Also maintain a healthy lifestyle by eating healthily and not smoking.

By doing activities that you enjoy, you’ll soon find that aerobic exercise becomes an established habit, and you will be able to enjoy all the health benefits that come with it!

 Patient pamphlet  For more information, see the patient pamphlet.

Article kindly written by:

Dr Stan P Woodhouse
MbChB FRACP
Clinical Associate Professor, University of Queensland;
Editorial Advisory Board Member: Virtual Cardiac Centre.

References

  1. Abraham W T et al. Cardiac resynchronization in chronic heart failure. NEJM. 2002; 346:1845-53.
  2. Belardinelli R et al. Low dose dobutamine echocardiography predicts improvement in functional capacity after exercise training in patients with ischaemic cardiomyopathy: prognostic implication. Am Coll Cardiol. 1998;31:1027-34.
  3. Briffa TG et al. Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia. Med J Aust. 2006;184:71-5.
  4. Carrel AL et al. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school based exercise program: a randomised controlled study. Arch. Pediatr. Adolesc. Med. 2005;159:963-8.
  5. Davey P et al. Ventilation in chronic heart failure: effects of physical training. Br. Heart J. 1992;68:473-7.
  6. Fiatarone MA et al. The etiology and reversability of muscle dysfunction in the aged. Gerontol. 1993;48:77-83.
  7. Kirkendall DT et al. The effects of ageing and training on skeletal muscle. Am. J Sports Med. 1998;26:598-602.
  8. Lipkin et al. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol. 1988;18:187-95.
  9. Piepoli M F et al. ExTraMATCH Collaborative Exercise Training Meta-Analysis of Trials in Chronic Heart Failure (ExTraMATCH). BMJ. 2004;328:189.
  10. Thompson PD et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology Circulation. 2003;107:3109-16.
  11. Tumminello G et al. Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance. Europ Heart J. 2007;28:673-8.