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Heart Health Special Report

Exercising Safely After a Heart Attack

Exercise can be a frightening proposition in the aftermath of a heart attack. Many survivors worry that stressing the heart—a muscle that has already been injured by the heart attack—will trigger a second episode. As little as a decade ago, doctors shared these fears and counseled their heart attack patients to avoid exercise.

But recent research indicates that a reasonable amount of regular exercise is the best way to strengthen the heart after a heart attack. Among the benefits: increased strength and stamina as well as better control of blood pressure, cholesterol, diabetes, and weight. Thus, heart attack survivors who exercise usually require less medication, are less likely to need bypass surgery or angioplasty, and are less likely to die of a second heart attack than those who remain sedentary.

To exercise safely, heart attack survivors need sound advice and careful supervision. Many heart attack patients have never exercised before; even those who have been active need to know how to exercise safely with their present health situation.

For virtually all heart attack survivors, doctors recommend a supervised cardiac rehabilitation program, which focuses on exercise training and nutrition as well as counseling and interventions to reduce risk factors such as smoking, high blood pressure, elevated cholesterol levels, and excess weight.

Such programs are so effective that they are now also recommended for people with almost any type of heart disease, whether or not they’ve had a heart attack.

After a Heart Attack: Starting an Exercise Program
Within a day or two of having a heart attack, your doctor will likely ask that you begin to move around, possibly by stretching and walking in your hospital room or the hallway. Then, before leaving the hospital, your doctor may recommend that you have an exercise stress test to see how much exercise your heart can tolerate.

If you don’t have a stress test before you leave the hospital, you may have one before starting the post heart attack rehabilitation program.

The results of the stress test will help determine the range your pulse needs to be in for you to gain the most benefits from exercise without putting undue stress on your heart. Usually, this range is 50% to 80% of the peak heart rate attained during the stress test. Your doctor will then give you an exercise “prescription” to follow when you begin an exercise program.

After a Heart Attack: Exercising After You’re Discharged
If a cardiac rehabilitation clinic is available in your area, your doctor may request that you exercise there in the first weeks after the heart attack. Exercising in a rehabilitation clinic will allow the staff to coach you in the correct ways to exercise and to monitor your electrocardiogram and blood pressure during exercise periods. If no problems are identified after about 6 to 12 weeks of supervised exercise, many heart attack patients can then exercise on their own, checking in occasionally with the rehabilitation staff.

Types of Exercise for Heart Attack Patients
Doctors recommend two types of exercise for people who’ve had a heart attack: aerobic cardiovascular exercise and resistance (strength) training. However, any sort of heavy lifting should be avoided until a heart attack patient has been doing cardiovascular exercise successfully for about a month.

Aerobic cardiovascular exercise. Aerobic exercise includes activities such as walking, jogging, cycling, cross-country skiing, rowing, and swimming. Your doctor and the cardiac rehabilitation staff will determine the exact type and intensity of exercise you should do. Although your initial workouts will likely be at a low intensity level and later ones likely will be more intense, a typical workout may include the following:

  • about 10 minutes of warm-up (that is, stretching or light walking, jogging, or cycling)

  • 20 to 30 minutes of more intense cardiovascular exercise

  • 5 minutes of cool-down (with activities similar to the warm-up)

  • Doctors usually request that heart attack patients exercise at least three times a week

To see whether you are exercising with the correct intensity, you may need to take your pulse or use a heart-rate monitor before, during, and after your workout. The cardiac rehabilitation staff may ask that you report these numbers to them when you check in. If your heart rate is not in the recommended range, you need to modify the intensity of your program. A less-intense exercise program may be more appropriate if you are severely ill, disabled, or frail; have a pacemaker; or take beta-blockers.

Resistance training. Lifting weights or using resistance machines or bands should be introduced slowly as your health improves. Your doctor may ask you to periodically substitute resistance-training exercise for a cardiovascular workout to help minimize muscle loss.

Ask your doctor or the cardiac rehabilitation staff what amount of weight or resistance to begin with. You will likely start by doing just a few repetitions and gradually build up to three sets of 12 repetitions. You may be asked to increase the amount of weight or resistance you use over time.

How Safe Is Exercise After a Heart Attack?
If you follow your doctor’s prescription for exercise, physical activity as part of a cardiac rehabilitation program is very safe. Studies show that only one cardiac death occurs for every 784,000 hours of cardiac-rehabilitation exercise. However, you still should be on the lookout for any symptoms that are indicative of a heart attack. If you experience any of these heart attack symptoms while exercising, stop and call your doctor.

  • For more Heart Health articles, please visit the Heart Health Topic Page

    Posted in Heart Health on April 20, 2007

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