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General Exercise Guidelines for Cardiac Rehab if You Have Heart Failure

Exercise guidelines for a person with heart failure include:

  • Always warm up and cool down.
  • Flexibility exercises.
  • Aerobic exercise.
  • Strength training.
  • Choose continuous rhythmic activities such as walking, cycling, or water exercises.
  • Listen to your body: Rest when you are tired, and remember that short periods of exercise are still beneficial.
  • Time your medicines with your exercise, If you exercise shortly after taking your medicine, you may become dizzy or faint. It is best to wait a while after taking your medicine before you begin your exercise.
  • Skip exercise if you:
    • Are not feeling well.
    • Have had a weight gain of 3 lb (1.4 kg) or more in 2 to 3 days (alert your doctor).
    • Have abnormal ankle swelling or bloating in your stomach.
    • Have had an increase in coughing or wheezing or shortness of breath.
  • Avoid extreme environmental conditions. If it is too hot or cold, exercise inside only.
  • Always wear loose, comfortable clothes and shoes that fit properly.
  • STOP exercising if you feel any:
    • Pressure or pain in your chest, neck, arm, jaw, or shoulder.
    • Dizziness, lightheadedness, or nausea.
    • Unusual shortness of breath.
    • Unusual tiredness.
    • Heartbeat that feels unusual for you: too fast, too slow, or skipping a beat.
    • Any other symptoms that cause you concern.

NOTE: Always check with your doctor before beginning a new exercise program.

1. Warm-up and cooldown

Warm up before you exercise, and cool down afterward—for at least 15 minutes each. This will help your heart gradually prepare for and recover from exercise and avoid pushing your heart too hard.

A good warm-up and cooldown consists of very light activity, such as slow walking or cycling, followed by stretching that focuses on the muscles used during the session.

2. Flexibility exercises

Stretching relaxes the mind and tunes up the body. Numerous benefits are associated with an increase of flexibility, such as improvement in overall balance, stability, and mobility. It also promotes good circulation, increases your level of relaxation, and just feels good.

A lack of flexibility is often associated with poor posture and low back pain. Stretch in a slow, controlled manner and continue to breathe through each stretch. Begin by trying each stretch once and gradually increasing the duration and repetition as you feel more comfortable. Carefully follow the recommended guidelines.

Make stretching a part of your warm-up and cooldown every time you exercise.

General guidelines for flexibility exercises

  • Frequency: Do stretching exercises at least 3 days a week.
  • Intensity: Stretch to a position of mild discomfort.
  • Duration: Hold each stretch 10 to 30 seconds.
  • Repetition: Do each stretch 3 to 5 times.
  • Type: Control and hold without resistance, with an emphasis on lower back and legs.

3. Aerobic exercise

Aerobic activities that are popular with people who have heart failure are walking and stationary cycling. Remember to first exercise at a low intensity. You can gradually increase the intensity and duration of your exercise sessions as long as your tolerance improves with no symptoms. Listen to your body by monitoring your rating of perceived exertion (RPE) and being aware of your heart rate. Your rehab team may give you a target heart rate range that is safe for you.

An example of a walking and cycling program for people who have heart failure is shown below.

Aerobic exercises

Mode

Walking Cycling (stationary)

Intensity

  • Slow to moderate pace
  • RPE: 11 to 14
  • Heart rate: within target heart rate range
  • Until tolerance if no symptoms
  • Little to moderate resistance
  • Comfortable pedaling speed
  • RPE: 11 to 14
  • Heart rate: within target heart rate range
  • Until tolerance if asymptomatic

Duration

Interval training
  • Exercise 1 to 6 minutes
  • Rest 1 to 2 minutes
Total exercise time
  • 10 to 20 minutes
Interval training
  • Exercise 1 to 6 minutes
  • Rest 1 to 2 minutes
Total exercise time
  • 10 to 20 minutes

Frequency

3 to 7 days a week 3 to 7 days a week

Progression

  • Gradual increase in duration
  • Gradual increase in intensity; RPE: 11 to 14
  • Gradual increase in duration
  • Gradual increase in resistance; RPE: 11 to 14

Stop exercising and alert your doctor if you experience angina (chest pain or pressure), shortness of breath, unexplained dizziness, or significant pain or discomfort.

4. Weight training

Weight training has been shown to be very effective for people who have heart problems. It can improve your muscular strength and endurance as well as help reduce cardiac risk factors. It also helps decrease how hard your heart must work during daily activities.

It is important that you follow your health professional's guidelines regarding correct technique, breathing, and intensity while you weight train.

By Healthwise Staff
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised September 27, 2012

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