Exercise With Heart Disease: Staying Safe

Why exercise helps the heart

• It makes the heart and muscles more efficient, so the same task needs less effort.
• It can lower blood pressure and improve cholesterol and blood sugar.
• It helps manage weight and reduces stiffness in blood vessels.
• It improves breathing, stamina and sleep.
• It reduces anxiety and low mood, which are common after heart events; see anxiety in older adults and depression in older adults.
• It supports independence and confidence.

For conditions such as heart failure, regular gentle exercise is now recommended for many stable patients, but needs medical supervision; see heart failure at home guide.

Talk to the doctor first: what to ask

Never start or restart exercise after a heart event, or increase it, without medical advice. At the clinic, ask:

1. Is my heart condition stable enough for exercise? Do I need tests, such as an exercise test or echocardiogram, first? 2. Can I join a cardiac rehabilitation programme? Where, and how do I get referred? These programmes are the safest way to restart. 3. What kind of exercise is suitable, how long and how often? 4. What effort level is safe for me? Do I need a heart rate limit, or should I use the talk test and perceived effort? Some medicines, such as beta-blockers, blunt the heart rate, making pulse targets unreliable. 5. Which activities should I avoid, such as heavy lifting, straining, sudden bursts or exercising in extreme heat or cold? 6. How do my medicines affect exercise? Do I need to take them before, or carry something for chest pain? Do I need to adjust any diabetes tablets? 7. What symptoms should make me stop, and what should I do? 8. If I have a pacemaker or defibrillator, are there limits on arm movement, heart rate or contact? 9. When do I come back for review?

Write down the answers. If something is unclear, ask again. Do not stop prescribed medicines or change doses because you feel well.

Who needs to be especially careful

Exercise is not safe, and medical review is needed first, in situations such as:

• chest pain at rest or new or worsening angina, or pain that is more frequent;
• a recent heart attack, heart surgery or stent, until the team gives clearance;
• uncontrolled high blood pressure or very low blood pressure;
• uncontrolled heart rhythm problems, fast or irregular heartbeat, or fainting;
• severe breathlessness at rest, or worsening heart failure with weight gain and leg swelling;
• severe narrowing of a heart valve, or other conditions as the cardiologist advises;
• a fever or acute illness.

Principles of safe activity

1. Start low and go slow. Begin with short, easy sessions, such as five to ten minutes of gentle walking or seated movement, and add a few minutes each week as your team agrees. See walking programme for older adults and chair exercises for seniors.

2. Warm up and cool down. Five minutes of gentle movement before and after, so that the heart rate rises and falls gradually. Never stop suddenly after strenuous effort.

3. Use the talk test and perceived effort. You should be able to talk in short sentences, but not sing. Effort should feel "light" to "somewhat hard", not "hard". If you cannot talk, slow down. Pulse targets only if your doctor gives them.

4. Regular, moderate activity beats occasional bursts. Many people aim for most days of the week, working up towards guideline levels (about 150 minutes of moderate activity a week) only as the team allows.

5. Avoid straining. Do not hold your breath, push very hard, or lift heavy weights. Light strength work with bands or light weights may be allowed, with breathing out on effort; see strength training after 60: how much is enough, but only with your doctor's agreement.

6. Stay hydrated, but follow fluid advice. In heart failure, your doctor may limit fluids; follow it.

7. Avoid exercising right after a heavy meal, after alcohol or when very tired or unwell.

8. Avoid extremes of heat and cold. Hot, humid weather strains the heart, and cold air can trigger angina or breathlessness. Exercise indoors in the cool hours; see exercising indoors in Indian summer and monsoon and heat stroke and dehydration in seniors.

9. Exercise with company where possible, and carry a phone and emergency contacts; see emergency contact card and medical summary.

10. Keep your usual medicines routine, and carry any prescribed emergency medicine for chest pain, as instructed by your doctor.

11. Know your usual readings. If your doctor asked you to monitor blood pressure or weight, do so; see how to measure blood pressure at home and daily weights in heart failure. A pulse oximeter has limits and is not a safety test for exercise; see pulse oximeter accuracy limits.

12. Do not exercise through symptoms. If it does not feel right, stop.

Warning signs: stop and act

Stop at once, sit down, and rest if you feel:

• chest pain, pressure, tightness, burning or heaviness, or pain spreading to the arm, shoulder, neck, jaw or back;
• unusual or severe breathlessness;
• dizziness, light-headedness or a feeling you may faint;
• a racing, pounding or irregular heartbeat;
• unusual sweating, nausea or a sense of doom;
• sudden, severe tiredness;
• new swelling of the ankles or sudden weight gain, in heart failure.

Call 112 immediately if chest pain does not ease within a few minutes of rest (or after your doctor's prescribed medicine, as instructed), if the pain is severe, if you faint, if there is severe breathlessness, or if you have signs of a stroke: face drooping, arm weakness, slurred speech; see stroke warning signs and first hour. Do not drive yourself. Sit or lie in a comfortable position, and follow the emergency operator's instructions. Follow any written emergency plan your cardiologist has given you. See ambulance and emergency numbers in India and after a heart attack: recovery at home.

Call your doctor the same day for new or worsening symptoms during or after exercise, even if they settle, such as more frequent chest discomfort, more breathlessness than usual, swollen legs or weight gain.

Cardiac rehabilitation

Cardiac rehabilitation is a structured programme, usually run by a hospital, that includes supervised exercise, education about the heart, medicines, diet and risk factors, and psychological support. Guidelines recommend it after a heart attack, bypass surgery, stent, for stable heart failure and some other conditions. It is the safest way to restart exercise, since staff monitor heart rhythm and blood pressure and tailor activity. Ask the cardiologist about a referral, and about home-based or tele-rehabilitation programmes if travel is hard. Not everywhere in India has access; if not available, ask the cardiologist for a written home plan. Do not design your own programme.

Special situations

• Heart failure: exercise is usually gentle and gradual, with attention to fluid, weight and symptoms; follow your team's plan.
• Pacemaker or defibrillator: you can usually exercise, but there may be limits on arm movements in the first weeks, heart rate settings and activities with impact; ask the device clinic.
• Atrial fibrillation: ask about target effort, and whether your heart rate control medicine alters your response; see atrial fibrillation and blood thinners. On blood thinners, avoid activities with a high risk of falls or bleeding.
• High blood pressure: regular activity helps, but do not exercise with very high readings; avoid straining; see hypertension home care guide.
• Angina: pace yourself, rest when needed, and carry prescribed medicine.
• After surgery: follow your surgeon's chest and wound precautions, which can limit arm use and lifting for weeks.
• Diabetes: coordinate with your diabetes care; see exercise with diabetes.
• Lung disease: see copd and chronic lung disease home care.
• Frailty: very gentle seated exercises; see frailty in older adults explained.

Everyday activity counts

Light everyday movement matters too: short walks, gentle housework, gardening in the cool hours, climbing a few steps with a rail, playing with grandchildren, standing up often rather than sitting for hours; see sitting for long hours. Avoid heavy lifting such as carrying full buckets or large luggage. Plan breaks, sit when you can and ask for help.

Family and carers

• Be supportive, not overprotective. Over-restriction leads to weakness and fear.
• Walk with your parent.
• Learn the warning signs and the emergency steps.
• Keep emergency numbers visible and know the way to the nearest hospital.
• Learn first aid and basic life support if you can.
• Encourage taking medicines and attending reviews.
• See motivating a parent to exercise.

When to ask a professional

Ask a cardiologist or doctor before starting or changing exercise, and after any new symptom. A cardiac rehabilitation team or physiotherapist can design and supervise exercise. A dietician can advise on heart-healthy eating; see nutrition for heart health after 60. A pharmacist can explain medicine effects. In an emergency, call 112.