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Physical Activity and Heart Failure

If you have experienced heart attack, heart failure or have been diagnosed with cardiovascular disease, what now?
After receiving treatment, what can you do to improve cardiovascular health and physical fitness?
The answer to both questions is cardiac rehabilitation.
Cardiac rehabilitation employ a number of medical programs designed by physicians that help a patient recover from serious heart problems. These programs are specialized to meet the specific needs of the patient. An entire panel of professionals including doctors, nurses, dietitians, exercise therapists and physical therapists work to provide a safe recovery.

Typically, a cardiac rehab program occurs in a series of phases and includes exercise, nutritional counseling, emotional support and education to reduce future risk. While members of a cardiac rehab team may provide patients with information for completing rehab program, many patients still have questions and concerns regarding the exercise portion of the program.

There are three common questions regarding the exercise portion of cardiac rehab.

When can I start to exercise?
What kind of exercise is safe?
How long will rehab last?

The exercise program often begins shorty after a heart attack or other complication. It is best for a program to start at this time. In the past, medical professionals believed that rest was most effective for cardiovascular health. However, recent studies found that for every week that patients delay post-surgery exercise programs; they have to train an extra month to obtain equal benefits. Thus, the best time to begin is when your physician clears you for physical activity.

The kinds of exercise that are safe depend on the stage of rehabilitation and individual circumstances. Beginning rehab, exercises will be simple and basic. For example, following surgery, rehab might include sitting up in bed, standing up and walking (assisted or unassisted) down the hall. This may seem too easy, but major surgery and other heart conditions can be draining. Early in recovery, everyday tasks can be difficult to execute and exhausting. That is why cardiac rehabilitation begins with activities that help restore normal mobility.

After a patient leaves the hospital, the exercise routine changes. Initially, exercise sessions take place at an outpatient rehab facility. The starting exercise routines will include aerobic exercise for 3-5 days a week and weight training for 2 to 3 days a week. Specifically, a patient will start out with walking, cycling or climbing stairs to improve cardiovascular health. They will also use free weights or weight machines to work on muscle strength. Frequently, patients will be encouraged to add physical activity to daily activities. This can be done with simple changes. Parking farther from a building and using stairs are examples that can work into an average day. Eventually, the patient can workout at home. For most rehab patients, this will be a significant milestone of personal independence.

It is worth noting that safety in a patient’s routine daily activities early on is NOT a major focus for patients. When exercising in the hospital or rehab facility, patients are closely monitored for blood pressure and heart activity. When patients are released to return to their homes, it is because the doctor believes the patient can exercise safely at home.

Rehabilitation schedules vary considerably from one person to another. Formal rehab could take six weeks, six months or longer. Some physicians recommend at least six months of exercise for the best recovery.

Example of a beginner at home routine:

Perform all exercises standing.
Remember to breath. Forgetting to breathe steadily during exercise can raise your blood pressure.
After the third day, add small weights (1-2 pounds).
Keep feet at shoulder width for all exercises.
Consult a physician before changing a prescribed routine.
Elbow Bends - Stand with elbows against your stomach and hands under your chin. Straighten your arms out forward. Return to the starting position and repeat.
Bent Arm Raises - Use the same starting position as elbow bends. Raise arms over your head. Return to the starting position and repeat.
Elbow Extensions - Use the same starting position as elbow bends. Extend your arms to the side, while keeping your elbow in place. Return to the starting position and repeat.
Straight Arm Raises - Place arms at your sides, straight down. Keeping arms straight, raise them in front as high as you can. Move slowly into the starting position and repeat.
Arm Circles - Put your arms straight to your sides, in line with shoulders. Move your arms steadily in small circles. Switch between forward and backward circles after 10 circles.

After 5 days working on the home routine, add the following exercises:

Marching In Place - Hold your arms slightly bent, as if in running position. Lift your legs by bending at the knee. Move your arms while you march.
Waist Bends - Rest your hands on your hips, with elbows bent. Keep your legs straight and bend at the waist to the right. Do the same for the left and repeat.
Waist Twist - Use same positioning as waist bends. Turn your upper body to the left and return to center. Do the same for the right and repeat.

After 7 days of home exercise add the following exercise:

Knee Touches - Start with your arms raised above your head. Bend over and touch your knees. Repeat the exercise.

After 3 weeks of home exercise add the following exercise:

Knee Bends - Hold your hands on your hips with elbows bent. Bend your knees to a comfortable position and return to standing.

There are some risks involved in exercise for cardiovascular health. Exercise may not be safe for patients with high blood pressure or severe heart disease. You rehab doctor will alter your routine to accommodate these conditions.

Exercise can cause injury to muscles or bones. In order to insure personal safety, it is best to contact a physician before proceeding with an altered workout plan.

Some symptoms may indicate health problems during exercise. These symptoms include chest pain, nausea, heavy breathing, severe fatigue, extreme sweating, abnormal heart rate change (either low or high), abnormal blood pressure and abnormal blood sugar. If any of these symptoms occur, immediately stop exercising and contact your physician.

What results can you expect from a cardiac rehab exercise routine?

Exercise will help build up your muscles and improve the health of your heart. This will lead to a more normal routine. You may find your life returning to the same pace as before your cardiovascular problems. Cardiac rehab can be a slow process, but the more you adhere to the prescribed exercise routine, the better your results will be.