Physical inactivity is sometimes neglected as one of the risk factors in heart disease. But along with smoking, hypertension, high cholesterol and obesity, physical inactivity can be just as harmful to the body.
For those patients who have had a heart attack, it takes about 4-6 weeks for your heart muscle to heal. This is known as the recovery period. During this time, the damaged heart muscle is repairing itself with scar tissue. Because of this, it is quite normal to feel more tired and week in the first 1-2 weeks. It is very important that you balance your activity with rest and gradual exercise so that you don't over-stress the heart while it is healing during this time. For those of you who have had a pacemaker insertion, follow the restrictions of no elbow elevation past 90 degrees (shoulder height) on the affected side for 6 weeks.
The following are recommended guidelines for exercise. However, the advice of your cardiologist always takes priority over these guidelines. You should always talk to your doctor prior to beginning any exercise program.
- Overdoing things. Know your limits and try to avoid angina, shortness of breath or extreme fatigue.
- Activities immediately after your meals. Wait at least 60 min after meals before exercising or doing strenuous activities.
- Burst Activities. Activities that are vigorous in nature and cause a sudden increase in heart rate are better tolerated with a warm-up.
- Very hot or cold environments. When your heart has to work harder either to warm or cool the body, exercise/activity may need to be decreased or avoided.
- Lifting heavy objects or weights. This type of straining exercise may produce angina or dizziness, and can sometimes cause increases in blood pressure.
- Saunas and hot tubs (Avoid for at least 4 weeks after your heart attack).
- Rest - Plan rest periods throughout the day. Stop activities before getting over-tired.
- Sitting - Sitting to work means that you are able to do more.
- Delegate - Ask others to do the jobs you find tiring or impossible.
- Pace - Work at an easy pace. Alternate light /moderate/heavy work throughout the day and week. Plan heavier work for those times when you have the most energy. Realize what your maximum work level is and have respect for the signs of fatigue that you experience. (People experience fatigue in different ways -shortness of breath, sore muscles, weakness).
- Prioritize - Neglect the tasks that can be performed less often, while saving energy for the most important ones.
- Simplify - Break an activity into parts if possible. Organize the area effectively to decrease unnecessary bending or reaching
You only have to take it regularly. Not seriously.
Significant health benefits can be obtained by including a moderate amount of physical activity (i.e. 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball) on most, if not all, days of the week. You can do these 30 minutes all in one go, or break it up into shorter sessions and you will get similar benefits! Walking a couple flights of stairs instead of taking the elevator, or parking further away from an entrance are some ways to increase physical activity. Pedometers are another way to monitor daily activity - some people set a goal of 1\0000 steps per day, or simply adding 2000 steps to their daily average. "No pain" does not equal "No Gain."
Exercise needn't be difficult - it just has to be regular. Here are some ideas to get you started: (remember that some household chores count too!) washing the windows or floors, sweeping outdoor areas, weeding the garden, shoveling snow, these are all vigorous enough to count as part of your daily 30 minutes (but should be done after the recovery period of a heart attack).
- Improves heart & lung function
- Decreases resting blood pressure
- Decreases body fat
- Decreases LDL ("bad") cholesterol
- Raises HDL ("good") cholesterol
- Increases energy level
- Improves sleep
- Increases tolerance to stress
- Controls or prevents diabetes
- Reduces risk of colon & breast cancer as well as osteoporosis
- Controls joint swelling and pain in arthritis
- Improves muscular strength and balance, reducing risk of falls
30 minutes a day, or take 10, take 10, take 10, and repeat.
Walking is the recommended exercise during the recovery period. Begin your walking program from what you were doing in the hospital (unless advised otherwise by your doctor ). Be sure to wear a good pair of running shoes. Comfortable, supportive shoes are especially important for those who have diminished circulation and sensation to the feet, which should therefore be cleaned and inspected daily for any open sores or cuts. Because exercise has an insulin-like effect, diabetics should consult their doctor regarding increased monitoring of glucose levels and modifications in diet and insulin when beginning an exercise program.
Setbacks- No exercise program ever goes smoothly. There may be setbacks (such as illness or injury), and you should not push through pain or feeling unwell. Persistent pain should be checked by a doctor before resuming exercise. Wait at least 2 days after the last symptoms of a cold have disappeared before resuming exercise. If you do have a setback, don't start immediately at your previous level of activity. It should take about as long to get back to your previous level, as the time you were out of action.
"Additional health benefits can be gained through greater amounts of physical activity. People who can maintain a regular, regimen of activity that is of longer duration or of more vigorous intensity are likely to derive greater benefit."
For those who already achieve the recommended daily 30 minutes of physical activity and want to increase their physical fitness, the following are general guidelines. A more individualized program would be established at a cardiac rehab facility.
Type: Aerobic exercise is continuous, light to moderate intensity, long duration that uses mainly the leg muscles to get the heart rate up (i.e. walking, bicycling, swimming). The type will depend on individual preference, availability of equipment and ability level. Weight lifting is an example of anaerobic exercise, and although increases muscle mass and provides functional benefits, does not provide the same benefits. It should be done at least initially under supervision to learn proper technique and progression to avoid injury. This is also part of a cardiac rehab program or can also be taught by a physical therapist.
Frequency: To improve/maintain your level of fitness you must exercise consistently, with no more than 2 days between sessions. Your goal is to exercise 3-5 times per week. If you have not exercised regularly before, beginning with a lower frequency such as twice a week is a good start.
Intensity: It is best to follow an intensity that does not reproduce symptoms, yet lets you feel like you are working "light to somewhat hard". This is often talked about in terms of Rate of Perceived Exertion (RPE). The Borg Scale is a way of matching your intensity to a number depending on how you feel. You should be working at an intensity somewhere between 11 and 14.
6
7 - Very, very light
8
9 - Very light
10
11 - Light
12
13 - Somewhat hard
14
15 - Hard
16
17 - Very hard
18
19 - Very, very hard
20 - Exhaustion
Talk Test:
You should also be able to carry on a conversation during exercise. If you are out of breath, or cannot talk in full sentences, you are working at an intensity that is too high.
Often exercise is prescribed in terms of a target heart rate. This is determined from an exercise stress test at a cardiac rehab facility. Prior to a stress test, a general guideline is to set your target rate to approximately 20 beats plus your resting heart rate, and gradually increase using the Rate of Perceived Exertion in the absence of symptoms. For two weeks after a heart attack, it is best to not exceed 20 beats plus your resting heart rate during exercise or activity.
Warm-up:
When you are exercising for at least 15-20 minutes continuously, it is important to include a warm-up into your exercise session to slowly increase the heart rate and reduce risk of injury.
Cool-Down:
A 5-minute cool-down of gradually decreasing in the intensity and stretching after exercise is also important to prevent muscle soreness, as well as some abnormal heart rhythms that may occur with an abrupt stop.
Duration:
Your goal is a total of 20-60 minutes of aerobic activity .The duration depends on the intensity of the exercise; the more intense the exercise, the less the duration needs to be. Remember the duration can be accumulated with continuous activity or intermittent bouts of minimum 10 minutes. Again, if you have not exercised prior to this point, just begin slowly even if all you can manage is 2 or 3 minutes. It is better to increase duration before increasing intensity.
Progression:
Do not progress too fast, especially during your recovery period after a heart attack, even if you are feeling terrific you need to let the heart muscle focus on healing. As a general guide line after a heart attack,
Week 1: 5-10 min.
Week 2: 10-15 min.
Week 3: 15-20 min.
Week 4: 20-40 min.
Don't forget to include lots of internal jogging - laughing and recreation are an important part of your health!
Flexibility and Joint Mobility:
Stretching should follow exercise to facilitate recovery and maintain flexibility. Hold the stretch for 60 seconds once on each side below the point of discomfort. Never bounce during the stretch. ( See last page )
Gentle stretching or range of motion exercises for all the major joints is especially important for those over age 50-60, and should be part of a daily routine to help stay limber and reduce joint pain.
Caution!!!
Stop exercising if you experience extreme shortness of breath, continuous pounding in your head, dizziness, pain in your chest, nausea or vomiting, or if you notice your heart skipping beats. You need to stop and rest until they have completely disappeared. If you have Nitroglycerin, take the medication as it prescribed to you. Do not resume exercise that day. Notify your doctor if these symptoms are new, or seem to be increasing in severity or time of onset. If these symptoms persist after a few minutes or longer than usual, are new in onset, or do not respond to your medication, call 911.
Sexual Activity
- Common sexual problems encountered by cardiac patients include reduced drive and/or depression (which may be due to medications such as beta-blockers, diuretics).
- Fear in both the patient and his or her partner of causing stress on the heart is common, so it is important to openly discuss these issues.
- Maximum heart rate, during sex averages 120bpm, which is similar to walking briskly for half a mile, or climbing 2 flights of stairs quickly.
- After a heart attack, it is recommended that you wait 2-4 weeks. In the absence of a heart attack, there is no restriction about sex after a cardiac cath or balloon procedure. You will only need to wait until the puncture site has closed. 24 hours is the usual time.
- Resume sexual activity as you feel able to.
- The change in heart rate and blood pressure is greater with an unfamiliar partner or surroundings, and after eating or consuming alcohol.
- Adapting less strenuous positions, such as side-to side rather than missionary positions and making sure you are well-rested can reduce cardiac stress.
Report any problematic symptoms to the physician or member of the rehab team.
Position. Stand by a chair or a, counter for support. Your feet should be shoulder-width apart, with one leg back and one leg forward. Stand tall, with your shoulders back and abdominals in. Check that your hips are square, your toes are pointing forward, and the forward knee is aligned with the ankle.
Movement for the calf stretch. Tuck the buttocks under, and straighten the knee that's behind you. Hold for 20-30 seconds. Repeat with the other leg.
Movement for the hip stretch. Place the knee on a chair (knee behind hip), and lean the hip forward. Hold for 20-30 seconds. Repeat with the other leg.
Movement for the thigh stretch. Grab the back foot and draw it toward the buttocks. Hold for 20-30 seconds. Repeat with the other leg.
Modification. Try this if you have trouble with the standard stretch: Hold onto a counter or chair for support. Place another chair behind you. Place one knee on the back chair and lean slightly forward until you feel a stretch.
Position. Sit on a chair or stand with your arms relaxed at your sides.
Movement. Lift right ear to ceiling. Grasp right hand above wrist (in front of body) and drop shoulders as you gently pull your right
This exercise helps loosen tight hamstrings. Do the self-test for hamstring tightness to see if you need to do this exercise. It is also a good exercise to do if you get muscle cramps in the back of your thigh. If you have unstable knees, or "back knee" (a knee that curves backward when you stand up), do not do this exercise.
A.
- Lie on your back, knees bent, and feet flat.
- Bend one hip so your leg is at about a right angle with the body.
- Slowly straighten the knee. Hold the leg as straight as you can as you count to fifteen.
B. You can also do this exercise by sitting with your foot on a low footstool. Rest your hands either on your thighs or at your sides. With your knee straight and toes pointed up, lean forward from the hips (back straight) until you feel a stretch on the back of your leg. Hold and count to fifteen. Relax.
Be careful with this exercise. It's easy to overstretch and be sore.
Position. Stand with your arms relaxed at your sides.
Movement. Squeeze shoulder blades together, then clasp hands behind body and extend arms. Keeping arms straight, gently lift hands and elbows toward the ceiling. Stand tall. Hold for 10-30 seconds.
Note: Hold the neck retracted while squeezing shoulder blades together.
Modification. This can also be done by placing hands on a doorway and passing your torso through the entrance.
Position. Sit tall with both buttocks on the chair. Place one ankle on the opposite thigh.
Movement. Apply pressure to the crossed thigh. Hold for 15 seconds. Move the opposite shoulder toward the crossed knee as you hug the knee into your chest and toward the opposite shoulder. Hold for 15 seconds. Straighten your back, and hold for 5 seconds. Repeat on the other side.
Goals. To keep your buttocks squarely on the chair. To sit tall with your back straight.
Modification. If this stretch is too difficult for you, it can also be done lying on the floor.
Position. Lie on your back with your knees bent. Place your ankle on the opposite knee.
Movement. Push your knee out by applying pressure to the crossed thigh. Hold for 15-30 seconds. Lift your shoulders off the floor, and hug the bent leg. Pull your foot off the floor as you move your knee toward your head (keep the thigh pressed out). Hold for 15 seconds. Repeat on the other side.
Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)
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