By Louis Neipris, MD
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A monitored exercise program, such as cardiac rehab, is usually advised for someone who has severe heart disease, is recovering from a heart attack or has had heart surgery. But if you have a minor, stable heart condition, or you have already gone through cardiac rehabilitation, your doctor may prescribe an exercise program that you can do on your own. Regular exercise can be safe and has many benefits. It can:
- Improve cholesterol levels. Exercise can help lower LDL (bad cholesterol) and raise HDL (good cholesterol).
- Help you manage medical conditions like high blood pressure and diabetes.
- Help you reach and maintain a healthy weight.
- Increase endurance, and improve muscular strength and flexibility.
Follow these steps to make exercise safe and enjoyable:
1. See your doctor. Even if you have no symptoms, but have a heart condition such as coronary artery disease or high blood pressure, it's important to talk to your doctor before you start or increase your exercise level. Also, see your doctor if you're middle-aged or older, have other medical problems, haven't exercised in a while or plan to start a vigorous program. The doctor visit to talk about exercise should include a discussion of:
- Medications. Let your doctor know about all of the medications you take. Some medications, such as beta-blockers, interfere with your body's response to exercise.
- Choices of exercise. Get clearance for a well-rounded exercise program. You may benefit from a fitness program that includes aerobic exercise (such as brisk walking, swimming or cycling), resistance training (weightlifting or strength training) and some kind of stretching routine, such as yoga. If you are elderly or frail, your doctor may advise you to start with a resistance training program with light weights and exercises that help you with balance and prevent falls. Resistance training has been shown to benefit even people who have heart failure (except those with heart valve disease).
- Cardiac rehab. If you've recently had a heart attack or have a more serious heart condition, your doctor may suggest a cardiac rehab program. Cardiac rehabilitation is supervised exercise, based at a hospital or outpatient facility, while your vital signs are monitored. It also includes counseling on healthy eating, smoking cessation and other lifestyle factors to cut the risk of further heart disease or a second heart attack.
- Exercise testing. If you don't have a prescription for cardiac rehab, your doctor may still refer you for exercise testing. Also called a "treadmill test," exercise testing usually involves running on a treadmill or riding a stationary bicycle while your heart, blood pressure and breathing are monitored. The test measures your cardiovascular response to exercise, helps reveal conditions like coronary artery disease and can determine what level of exercise is safe for you.
- Target heart rate zone. This is the zone, or range of heart rates (pulse rates), within which your doctor advises you to exercise so you can get the most benefit from your workout. An example of a target heart rate zone for a person in good health is 50 percent to 85 percent of your maximum heart rate. Maximum heart rate is measured as 220 minus your age. Depending on your age and condition, your own target heart rate zone may be different. Fall below the zone, and you may not be exercising intensely enough. Exceed the zone, and you risk putting too much strain on your heart. Your physician can help you find a target heart rate zone that best matches your needs, goals and physical condition.
- Frequency of exercise. The American Heart Association and American Council on Exercise recommend an exercise goal of at least three to four times per week for at least 30 minutes. If you're out of shape, ask your doctor about working out for 10 minutes two to three times a day at first before doing a full 30 minutes. These mini-workouts are still very beneficial.
2. Warning signs. Before you start an exercise program, it's important to be aware of any symptoms your might have had that would make working out dangerous. Do not exercise, and call your doctor, if you have had any of these symptoms in the past:
- Pain or pressure in the left or mid-chest, left neck or shoulder area during or right after exercise
- Developed chest pain within the last month
- Passed out or fainted during or after exercise
- Dizziness or a feeling like you're going to fall during exercise
- Shortness of breath or severe fatigue after mild exertion
- Joint or muscle pain that gets worse with exercise
3. Call 9-1-1 for:
- Crushing or tearing chest pain, pressure, heaviness or tightness
- Any chest pain, pressure, heaviness or tightness along with any dizziness, lightheadedness, passing out, sweating, nausea, vomiting, palpitations or very fast, slow or irregular heartbeat
- Chest pain that is not relieved with nitroglycerin
- Shortness of breath or extreme labored breathing
4. Follow exercise guidelines regarding:
- Hydration. Drink water before exercising and periodically during your workout, even if you don't feel thirsty. But follow any fluid restriction guidelines from your doctor.
- Weather. Avoid extremes in weather. Very cold, or hot, humid weather can put a strain on the heart and circulatory system. Stay indoors and exercise in a temperature-controlled environment.
- Interruptions to your routine. If you've interrupted your exercise routine due to vacation, sickness or inclement weather, ease back into your workout program.
- Phased workouts. Every workout should include three phases: a warm-up, a conditioning period and a cool-down. Start with a full 10- to 15-minute warm-up, such as walking on a treadmill to increase your breathing and circulation gradually. Most of your workout is in the conditioning phase, during which you slowly increase the intensity of exercise. Cool-down for a few minutes by decreasing the activity of your conditioning exercise.
- Heart rate zone. Stay within your target heart zone.
Is it safe?
You may worry that you'll have a heart attack or another problem while exercising. This is a normal worry. But rest assured that research shows complications during cardiac rehab programs are rare. Also, the overall risk of a cardiac event appears to be reduced in persons who are regular exercisers.
- Arena R, Myers J, Williams MA, et al. Assessment of functional capacity in clinical and research settings. A scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329-343.
- American Council on Exercise. Exercising with heart disease. Accessed: 06/21/2010
- American Heart Association. Physical activity. Accessed: 06/17/2010
- Chodzko-Zajko W, Schwingel A, Park CH. Successful aging: the role of physical activity. American Journal of Lifestyle Medicine. 2009;3(1):20-28.
- Pina IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: A statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention Circulation. 2003;107:1210-1225.
- American Heart Association. Target heart rates. Accessed: 06/21/2010
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