How to exercise safely at home with a heart condition
Whether you are newly diagnosed or new to exercising in an unsupervised environment, you’ve probably asked yourself this question: How can I exercise safely if I’m not being monitored?
There are several aspects to consider when answering this question.
- When can I start?
- Can I monitor myself?
- What should I look out for?
When is it safe to start exercising after a heart attack or surgery
If you’ve had a recent heart attack or surgery, the hospital staff would have likely got you up and about very early in your recovery. Early movement and mobility is essential to your recovery and quickens the process [Reference 1]. You should start on a home walking program as soon as you’re discharged. Start with short bouts of 5 minutes or so then gradually build up as you start feeling better.
The first 4 weeks
To exercise safely at home after a heart attack or surgery, it is recommended that you only perform light to moderate intensity exercise in the first 4 weeks as your heart muscle is still recovering at this stage. You may also be on new medications that your body needs to get used to. Your exercise program at this stage usually just involves walking, light resistance exercise and stretching or some movements.
If you’ve had a big surgery such as an open-heart surgery or a device implanted, you may have to wait a little longer than 4 weeks (usually 6-8) before including more exercises aside more walking and stretching. This gives your body more time to heal and for any wounds, grafts and device parts to securely attach and heal. You will also see your surgeon in this time and they will be able to give you specific advice on what you can or can’t do yet.
Going beyond the first 4 weeks
Exercising safely after the first 4 weeks (or a bit longer depending on your circumstances) is where we get to have some fun. This is where we get to know more about you and your needs, wants and goals and develop a personalised program and plan for your recovery. For example, if your goal is to comfortably return to your daily routine and be able to play with your grandchildren your program will look very different to someone who wants to return to playing a sport such as tennis or competitive cycling. Or maybe you’ve come out of this experience and decided you want to make the most of your new-found love for life and take part in a 10km fun run. Whatever your goal is, we want to help you get there.
At this stage, your exercise program usually consists of aerobic (cardio), strength and flexibility exercises. Other exercises may be included (e.g. balance exercises) depending on your other needs.
One of the biggest things that will dictate how fast your recover is your previous exercise habits. People who have previously been quite active (whether through exercise or having a physically active job such as farming or being a tradie) will recover faster physically and mentally. They will be able to get back to their previous level of fitness (or close to) faster and tend can generally increase their exercise and activity levels quicker.
Having said that, if you have no history of regular exercise or activity and you start a safe and structured exercise program, we also see big increases in fitness, strength, quality of life and mood. While your exercise levels may be progressed at a slower rate (to give your body more time to adapt), you will still see noticeable changes in your ability to do your day-to-day tasks such as gardening and mowing the lawn, cleaning the house and playing with grandchildren. You will find that you can move about more easily and with less effort, and you don’t feel as tired after activities such as mowing the lawn either.
How can i monitor myself?
When you go to exercise sessions in a cardiac rehab facility, you will usually have your blood pressure and heart rate checked before and after each session (sometimes other measures are also taken). You can still do this at home if you have a blood pressure monitor and record the numbers before and after each exercise session (e.g. a walk) into a journal. This can be particularly helpful if you are being ‘supervised’ remotely, such as an online cardiac rehab program, and can provide useful information about how your body has been responding to exercise.
heart rate monitors
Heart rate monitors can be useful but there are a couple of precautions you need to be aware of. If you’re on a medication that controls your heart rate (such as a beta blocker – anything ending in “-olol”), then trying to figure out what intensity you should be working at based on your heart rate isn’t appropriate. Also, a lot of the heart rate monitors available measure your heart rate at your wrist, which isn’t allows accurate. If you want to monitor your heart rate then getting one with a chest strap is much better.
steps per day
Other ways to monitor your activity levels are steps per day or time spent walking, cycling or dancing. These are easy to measure and most smart phones already include an application which can count your steps (although this means you need to have your phone on you for most of the day). Alternatively, activity monitors (with or without the heart rate monitor) are also useful for tracking activity time and step counts. Research has shown that whatever level you start at, if you increase your daily step count by 2,000 steps then you have a 10% lower cardiovascular event rate (for example, a heart attack) [Reference 2].
rating of perceived exertion
A valid and reliable way to measure the intensity you are working at is to use the Borg rating of perceived exertion scale [Reference 3]. This scale, shown below, asks you to pick a number that corresponds with how hard you feel you are working. A rating of between 11 and 13 is classified as moderate intensity while 15+ is used for vigorous intensity.
Another easy-to-use method is the talk test method. If you can:
- sing while doing the activity, then it is light intensity.
- talk freely but not sing, then it is moderate intensity exercise.
- are struggling to string together full sentences without taking a breath, then it is vigorous intensity.
When you are just starting out, stick with light to moderate intensity. We caution vigorous exercise if you’re early in your recovery and prefer you chat with your health professional prior to including this type of exercise. But some people are really good at understanding their own bodies and know when it is appropriate for them to start pushing harder.
general advice and precautions
To make sure you are exercising safely at home, keep in mind the following:
- Wear loose, comfortable clothing and supportive flat shoes
- Carry angina tablets or spray with you, if prescribed
- Avoid exercise if you are unwell or recovering from a recent illness / hospitalisation
- Do not exercise immediately after eating a large meal
- Avoid exercising in extreme hot or cold temperatures as this will add extra stress on your heart
- Consult your doctor or Exercise Specialist before considering swimming
- Stop exercises that cause you pain
When should you stop exercise?
If you experience any of the following symptoms, STOP the activity and rest.
- Excessive tiredness or unexpected fatigue
- Shortness of breath that is severe or persistent (more than normal for you)
- Angina: pain, pressure or tightness in your chest, neck, shoulder, jaw, throat, back or arm. If you have these symptoms, stop immediately and seek assistance. Take your angina tablets or spray, if prescribed.
- Irregular heartbeat, palpitations or a heart flutter sensation
- Dizziness or light-headedness
- Nausea or feeling sick in your stomach
- Excessive sweating
- Cold and clammy sweating
- Muscle cramps
- Severe pain in legs – joints, feet, ankles
If your symptoms persist, seek medical advice. If you have any doubts about the amount of exercise safe for you, ask us for guidance.
The physical activity guidelines are at least 150 minutes of moderate intensity exercise per week (or 75 minutes of vigorous exercise per week, or a combination) for general health and well-being. More may be better and usually won’t be harmful. But too much too soon can be so if in doubt please don’t hesitate to contact us contact us.