By Richard Josephson, MD, as told to Stephanie Watson
In the mid-20th century, it was feared that people with cardiovascular disease could injure themselves if they exercised. Previously, people with heart failure were bedridden for long periods of time. We now know that exercise, when done safely, does not damage the heart. It can actually protect the heart and reduce the chances of future problems.
In most people with heart failure, the main symptom is exercise intolerance, which people often describe as fatigue or shortness of breath. You may feel tired, unable to work, or have trouble walking down the street or around your house. Staying active can help your body work better.
Although you can start exercising on your own, I don’t recommend it. It is safer for people with heart failure to exercise in a place where they are supervised and supported during training. This is where cardiac rehabilitation can help.
What is cardiac rehabilitation?
Cardiac rehabilitation is a supervised program that helps you do more and feel better while you do it. It helps condition your body to work harder, so you can perform tasks, chores, and activities with far fewer symptoms. It can also reduce the likelihood of you going to the hospital. It can also help you live longer.
The core of this program is exercise-based therapy. This is usually aerobic exercise, with some resistance or strength training. Often flexibility and balance are also part of it. Cardiac rehabilitation also covers nutrition and diet, and provides education on the process and treatment of heart failure.
One of the key elements is that it is individualized. The difference between attending a cardiac rehab program and taking a Zumba or spinning class at your local gym is that the exercise program is tailored to you. The other key feature is that it is supervised and run by competent health care providers.
First, you go through an assessment to check your abilities and limitations. Then the staff creates an individualized program, with your input.
A health team will oversee your program, including a doctor, nurses and exercise physiologists, with the help of dietitians and psychologists or counsellors. Staff will monitor your symptoms and vital signs like your blood pressure, EKG, and blood oxygen levels to ensure you are exercising safely.
Your cardiologist or primary care physician should also be involved. You’ll need to get a prescription from one of your doctors to participate in a cardiac rehab program, and they can monitor your progress while you’re at it.
What types of exercises are best for people with heart failure?
Aerobic exercise is the foundation of physical activity for heart failure. This includes any type of exercise that gets your heart pumping and causes your body to need more oxygen. This usually involves using large muscle groups like the upper arms and legs.
Swimming, walking or biking all count as aerobic exercise. These are great additions to your cardiac rehab sessions, and you can continue them after you finish your program. Do the type you prefer, so you know you’ll stick with it for the long haul.
Other types of exercise may also be beneficial, including strength training. Yoga and tai chi help with balance and flexibility. They can also be very calming.
How often should you exercise and for how long?
To improve your cardiovascular health, you need to exercise at least 20 minutes a day, 3 to 4 days a week. Although more exercise might be better, there’s probably not much benefit to going over 60 minutes a day. If you want to spend an hour exercising, you can do aerobics for 45 minutes and strength or flexibility exercises for 15 minutes.
People who are just starting out may only be able to exercise for 5 minutes at a time. It is very good. Do 5 minutes of exercise, rest, then do another 5 minutes of exercise. Ultimately, you can aim for the full 20 minutes.
Most cardiac rehabilitation programs take place three times a week for several months, for about 36 sessions in total. During this period, exercise intensity gradually increases, which is important to help your heart work better. If you walked on a treadmill for the same amount of time and at the same setting for years, you’d never be in better shape.
Who shouldn’t exercise?
If you can barely get out of bed or walk around the room without the aid of a walker, you are not a good candidate for exercise or cardiac rehabilitation. That doesn’t mean you can never exercise. You can do physical therapy for a few weeks to improve your balance, strength, and ability to walk. Once you feel stronger, you can enroll in cardiac rehab.
What symptoms should make me stop exercising?
If you feel tired or short of breath at an unusually low level of exercise, that should be a red flag. For example, if you can normally exercise for 10 minutes and you become out of breath after 2 minutes, talk to your doctor or exercise physiologist.
More potentially dangerous symptoms are things like lightheadedness or lightheadedness, chest pressure or pain, and irregular heartbeat. A cardiovascular rehabilitation program should monitor these types of symptoms. If the staff checks your blood pressure, heart rate and oxygen level and finds that your measurements are correct, you should be able to continue exercising.