The Dos and Don’ts of Exercising with Heart Disease

By Elizabeth Millard |

Follow these eight rules to help keep your heart strong.

Exercising with heart disease

You know that exercise can help keep your heart healthy. “It can lower blood pressure, help you with weight control, and improve insulin sensitivity and blood lipid profile,” says Laila Al-Shaar, Ph.D., a researcher at the Harvard T.H. Chan School of Public Health.

What you may not realize is that exercise can also nurse a sick heart back to health. Research in Medicine and Science in Sports and Exercise found that over a 14-year time frame, those who exercised regularly after a heart attack were much less likely to have another, compared with those who didn’t exercise.

And it doesn’t take a lot of time or effort. People with heart disease who walk briskly for as little as 10 minutes a day have a lower risk of health issues than those who don’t walk, according to a study in the Journal of the American College of Cardiology.

That doesn’t mean that just anything goes, however, when it comes to working out. Follow these rules for exercising with heart disease.

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Do: Talk to Your Doctor First

Your situation is unique, so it’s best to get a personalized plan that factors in things like your personal medical history and specific medications. Your doctor may recommend supervised cardiac rehabilitation before you embark on a self-directed exercise program. This can be a helpful step in learning how to track your heart rate, blood pressure, and exertion levels.

Don’t: Do Too Much, Too Soon

If you’ve been inactive, it can be tempting to jump in to an exercise program that’s vigorous as a way to catch up on the time you’ve missed. But that can backfire.

“With any cardiovascular disease, your system changes,” explains Samantha DuFlo, D.P.T., a certified running coach at Indigo Physiotherapy in Baltimore. “For example, the walls of your arteries can stiffen, causing the heart to do more work. That means it takes time for these systems to adapt without overtaxing them.”

The good news is that a gradual approach to training can help with that adaptation, so you won’t always have to keep the intensity down.

Do: Progress Slowly

There are three main components of exercise—frequency, duration, and intensity—used to progress in any training program. To avoid overdoing it, you’ll want to focus on increasing one component at a time.

For example, start with 10-minute, low-intensity sessions two times a week. Then, increase the duration by about five minutes per session every two to four weeks, suggests Sheri Saperstein, C.P.T., a functional fitness specialist and owner of Fire Up Fitness in Boston.

From there, you can begin to increase frequency. Add a day or two each week, working up to at least five days a week—even if it’s slow-paced like gentle yoga. As you add days, it’s okay to cut back on the duration if needed. Just build back up to your previous duration before adding another day of exercise. Finally, increase the intensity of your workouts to a moderate level by picking up the pace—from walking to jogging, for instance—or by lifting heavier weights or doing more reps when strength training.

Your goal should be:

  • 150 minutes of moderate-intensity aerobic exercise, such as walking, cardio dance, cycling, or swimming
  • Two or three days a week of some type of strength training, such as using dumbbells, resistance bands, or bodyweight exercises

Don’t: Skip Your Warmup

Getting ready to exercise is crucial, says DuFlo. It not only preps your muscles for more activity but also gets your heart and nervous system ready as well.

Start with dynamic stretching, which means moving slowly as you stretch—instead of static stretching, which involves holding a stretch while staying still. Gently easing into exercise allows your heart rate to gradually increase, minimizing stress on your heart.

Do: Check the Weather

Extreme temperatures can strain your heart more than normal. So, heed weather advisories and move your workouts indoors when it’s not safe to be outside. It’s also wise to check with your doctor to find out whether you should take any additional precautions.

If you do venture out when it’s cold, do your warmup indoors beforehand, reduce the intensity and duration of your workout, and cover your mouth and nose with a scarf to warm cold air and reduce stress on your heart.

Similarly, high temperatures cause the heart to work harder and can increase your risk of a heat-related illness. If you’re exercising outdoors when it’s hot, do so in the morning or evening when temps are cooler. Also, stick to shady areas and make sure that you’re hydrated.

Don’t: Hold Your Breath

It’s more common than you may think, especially when lifting weights. But for someone with heart disease, this is a particularly bad habit.

“Also known as Valsalva, holding your breath when lifting heavy things can strain the heart, as well as lead to a rapid increase in blood pressure,” DuFlo notes. An easy way to prevent this is to count reps out loud, since you can’t hold your breath while talking.

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Another move to avoid, adds Saperstein, is getting up too fast from lying down. This also changes your blood pressure quickly, which can result in lightheadedness, dizziness, and additional stress on your heart.

Do: Monitor Your Exertion

You want your heart to work a little harder, but not too much. Heart rate monitors and fitness trackers are one way to keep tabs on it. Many now pair with an app that will show you the history of your cardiovascular effort over time.

“Some devices let you track other variables that matter to heart health, such as sleep patterns, food, how well you rest, and how quickly you recover from exertion,” says Rocky Snyder, C.S.C.S., a personal trainer and owner of Rocky’s Fitness Center in Santa Cruz, California.

If you don’t have a heart rate monitor or your doctor has told you that some of your medications may affect your heart rate, you can use “perceived exertion,” which means how hard you think you’re working based on a scale of 1 to 10, with 1 being the easiest and 10 being the hardest.

For those with cardiovascular disease, starting at an easy (3 or 4) or moderate (5 or 6) rate of exertion is recommended as you get used to activity. You should be breathing a little harder but still able to talk.

Don’t: Ignore Warning Signs

Listen to your body and pay attention to warning signs that you may be overdoing it. According to the National Institutes of Health, these include:

  • Feeling like your heart is racing or skipping a beat
  • Breathing so heavily that you feel like you can’t catch your breath
  • Dizziness or lightheadedness
  • Nausea
  • Pain in your chest

If you have any of these signs of overexertion, take a break by moving slowly or simply walking around. If they don’t resolve within a few minutes, seek medical attention.

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