Health Library Activity and Exercise for Heart FailureFrom Healthwise

When you have heart failure, it is very important to exercise regularly. If you are not already active, your doctor may want you to begin an exercise program. Of course, a safe level of exercise will depend on your specific diagnosis and stage of heart failure. But even if you can only do a small amount of exercise, it is better than not doing any exercise at all.

Key points

• Have a checkup before beginning an exercise program. Your doctor probably will do an electrocardiogram (EKG or ECG) and possibly an exercise stress test to see how much activity your heart can safely handle.
• Your doctor may recommend a supervised cardiac rehabilitation program at a local hospital or clinic. For more information, see the topic Cardiac Rehabilitation.
• Start out slowly, exercising for only a few minutes at a comfortable rate. Then each day, try gradually to increase the length of time and the intensity of your workout.
• You should not exercise during times when your heart failure is not under control.
• Set goals that you can reach. If you expect too much, you are likely to become discouraged and to stop exercising.

 What do I need to know about exercise and heart failure?
 Why do I need a regular exercise program?
 How can I get started on an exercise program?
 Where to go from here

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Do not start exercising until you have talked with your doctor. The American Heart Association recommends that your exercise program include activities that you can do at least 3 to 5 times a week.¹ You may need a day of rest between sessions. Exercise programs usually include:

• Stretching for 10 to 15 minutes, which helps warm up muscles before exercising. Beginning yoga or tai chi exercises might help increase your flexibility.
• Walking, cycling on a stationary bike, using a treadmill, doing low- or no-impact aerobics, and swimming, which all are exercises that strengthen your muscles, help you keep your balance, and improve your conditioning. Exercising for 20 to 30 minutes is recommended by the American Heart Association.
• Strength-building exercises using light weights, which helps increase the tone and strength of your muscles.
• A cool-down period. This means gradually stopping your exercise, such as walking at a slower pace for 5 to 10 minutes.

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Exercising 3 or 4 times a week consistently is important because it takes only a short period without activity to weaken your muscles and your cardiovascular system.

Regular exercise also helps reduce:

• Chest pain (angina) and symptoms of heart failure.
• Cholesterol, especially when combined with lifestyle changes, such as eating a balanced diet, not smoking, and reducing stress.
• Blood pressure. When combined with other lifestyle changes, such as eating a balanced diet and learning to handle stress, regular exercise can decrease your risk for coronary artery disease.
• Your weight, or it can help control your weight, which can decrease your risk for coronary artery disease and diabetes.
• Blood sugar levels, which can lower your risk for diabetes.
• Stress. It also helps lift your mood and decreases depression and anxiety.

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You can get started by doing the following:

• Have a thorough physical exam before starting any exercise program. Your doctor may do an electrocardiogram (EKG or ECG) and possibly an exercise stress test to see what level of activity your heart can handle.
• Make a list of questions to discuss with your doctor. Do this before your appointment. For some general questions, see the exercise planning sheet(What is a PDF document?).
• Make an exercise plan together with your doctor. An exercise program usually consists of stretching, activities that increase your heart rate (aerobic exercise), and strength training (lifting light weights). Visit a library or bookstore for information on exercise programs. Join a health club, walking group, or YMCA. Many cities have senior centers that offer inexpensive exercise programs. See the Other Places to Get Help section of the topic Heart Failure for additional resources.
• Learn how to check your heart rate. See taking a pulse. Your doctor can tell you how fast your pulse (target heart rate) should be when you exercise.
• Start out slowly. Try parking farther away from the store or walk the mall before shopping. Over time, you will increase your ability to do more.
• Keep a record of your daily exercise. It is okay to skip a day occasionally or to cut back on your exercise if you are too tired or not feeling well.

Tips for exercise success

• Set realistic goals. If you expect too much, you are likely to become discouraged and to stop exercising.
• Choose a type of exercise that you enjoy.
• Give yourself time. It can take months to get into the habit of exercising. After a few months, you may find that you are looking forward to it.
• Stay with it. It can be hard to stick with an exercise plan. Try exercising with a friend—it is much easier to continue an exercise program if you are exercising with someone else.
• Reward yourself. Build in rewards along the way that help you continue your program.

When starting an exercise program, keep the following precautions in mind:

• Pace yourself by alternating exercises. Rotate light workouts, such as short walks, with more strenuous exercises, such as low-impact aerobics or swimming.
• Avoid exercising outdoors in extreme temperatures or high humidity. When the weather is bad, try exercising indoors at a gym or walking at a mall.
• Avoid exercises that require or encourage holding your breath, such as push-ups, sit-ups, and isometric exercises. Also avoid heavy lifting.
• If you develop palpitations, chest pain, difficulty breathing, or dizziness or lightheadedness, stop exercising and rest. Call your doctor if these symptoms don't go away.
• Do not take hot or cold showers or sauna baths after exercising. Moderate temperatures are best—very hot or very cold temperatures can be dangerous.
• Ask your doctor about continuing your exercise program if your medicines change. New medicines can affect how fast your heart beats and how you feel when you exercise.
• Don't take naps or lie down after exercise because that reduces exercise tolerance. Instead, sit down to rest.
• Take your pulse frequently or wear a heart rate monitor and keep your pulse within the range your doctor sets. Watch your pulse when walking up hills or stairs.
• Be aware of how you feel while exercising. You should be able to talk easily without being out of breath.
• Make sure you adjust your exercise program if it is interrupted for more than just a couple of days. Gradually increase to your regular activity level as tolerated.

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Now that you have read this information, you are ready to plan the exercise program that suits you.

Talk with your health professional

If you have questions about this information, take it with you when you visit your doctor. You may want to use a highlighter to mark areas or make notes in the margins of pages where you have questions.

If you would like more information on heart failure, the following resource is available:

Organization

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Citations

1. Pina IL, et al. (2003). Exercise and heart failure: A statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation, 107(8): 1210–1225.

Author:	Robin Parks, MS	Last Updated: September 1, 2006
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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