Should you exercise after suffering a heart attack?

Being diagnosed with heart disease is tough enough on you, undergoing a heart surgery is worse. You have umpteen doubts in your mind about what your diet and whether you can exercise or not. In this post, Dr Aashish Contractor, an preventive cardiologist and a member of the medical team of the Standard Chartered Mumbai Marathon and an avid marathoner himself tells us more about exercising after undergoing a heart surgery or procedure:

How does one know if they are fit to exercise?

Before starting any exercise program, patients should complete a thorough examination, including medical history, physical examination, and a graded exercise stress test (where the intensity of the exercise is gradually increased to see the patient’s ability to exercise). That being said, there are a few people for whom exercise may not be well suited. Patients with conditions like unstable angina, severe heart valve problems, uncontrolled cardiac rhythm abnormalities, or other medical conditions that can be aggravated by exercise should put it off until the problems are controlled.

Under all circumstances it is important for a patient with pre-existing CAD should get a re-evaluation done regularly and as indicated by his/her doctor. This is usually done two to three months after starting a program, and once the patient has fully recovered he/she should go back for a re-evaluation every year. (Also read: Get a health check-up before you decide to take up running: Dr Aashish Contractor)

When is the right time to start physical exercise?

It is essential that the patient start any physical activity after two weeks of the incident – a heart attack, bypass surgery or angioplasty – since, as doctors we want to negate the ill-effects of continuous bed rest that the patient has been on. He/she can start with slowly walking and gradually increase the distance and speed depending on how well they feel. Another good method is to use one’s arms or upper body to exercise. By this I mean that the patient can rotate their arms in front of them or on their sides. This can be done as a method to ease them back into physical activity. It is important for bypass patients to remember that they should do this exercise cautiously, without impairing the healing of the sutures on their chest.

Is it important to exercise under medical supervision?

In the case of patients who have had surgery or a cardiac episode, it is best that they undergo tests such as a stress test to determine how much they should exercise. In the case of patients who suffer from CAD but have not had surgery, these tests are much more important to avoid a cardiac incident.

After an initial clearance from one’s doctor, it is highly recommended that the patient enrol in a formal cardiac rehabilitation program with telemetry monitoring (constant monitoring of one’s heart beat using a portable device). This will ensure a high degree of safety while the patient is exercising.

A cardiac rehabilitation programme is usually tailored to one’s needs and their medical condition. (Also read: Cardiac rehabilitation for a healthy heart (Expert speak))

Read more about causes, symptoms, diagnosis and treatment of heart disease.

What exercises can one do?

Most patients need to build their cardiovascular endurance, and condition their heart to withstand strain. Exercises such as walking, jogging, bicycling, swimming, group aerobics etc. are all called continuous exercises that are great for patients with heart disease. Activities that entail running or jumping are considered high impact exercises and may cause injuries in elderly patients. Therefore they are best avoided by them and those people who are largely unfit. In addition to this some patients can try strength training, but this should be done under the supervision of a physician.

What is the safe limit for one’s heart while working out?

In the case of heart patients, their heart rate is measured very closely. The intensity with which one works out can be measured using two variables – their heart rate (which is measured by their pulse) and/or their rate of perceived exertion (this is a subjective rating that is measured using a scale known as the Borg RPE scale).

There is a general formula to measure one’s optimal heart rate during exercise, it is as follows:

Predicted maximum heart rate = 220 – patient’s age. Here one has to factor in the fact that while exercising one’s heart rate should be between a range of 55% to 85%.

For example: For a person aged 60, the predicted maximal heart rate is 220-60 = 160 beats per minute. The target heart rate range will then be 160 X 0.55 (55%) = 88. This indicates the lower limit of the person’s heart rate and 160X0.85 = 136 indicate the upper limit of his/her heart rate. Therefore from this example the man should exercise and maintain his heart rate between 88 to 136 heartbeats per minute.

The lower limit of one’s heart rate should be maintained by elderly people and those who are just starting out on a fitness regime, and the higher limit can be maintained by slightly fit people and those who are younger. Here it is important to note that this reading should coincide with your stress test limits. Do not overexert yourself without your physician’s advice.

One can measure their heart rate by feeling the pulse at the base of the thumb. Count the number of beats for ten seconds and multiply this number by six, to get the total number of heart beats per minute.

Patients who are unable to monitor their heart rate should be trained to use the Borg RPE scale. This is a subjective scale but correlates well with one’s heart rate. On this scale patients should exercise at an RPE 11-14. However, certain high-risk patients need a more precise knowledge of their heart rate and should have it monitored continuously. It is important to make sure that the intensity should be set below a level that can cause chest pain, palpitations or other associated symptoms

Borg Scale of Rating of Perceived Exertion (RPE)

The recommended duration is 20-60 minutes of continuous or intermittent aerobic activity or exercise. Depending on the intensity of the exercise one is doing the duration usually changes. The rule of thumb is the lower the intensity the longer the exercise. Recent research has shown that exercise can be divided into intermittent bouts of 10 minutes each, instead of all at one time. It derives almost the same cardiovascular and health benefits as a long high intensity workout. This is particularly useful for patients who are unaccustomed to physical activity and are unable to perform long continuous bouts of exercise.

How long can one work out?

Patients with CAD should engage in individually designed exercise programs, unless they are advised not to. These programs should include a pre-exercise medical evaluation, graded exercise test, and an individualized exercise prescription. High-risk individuals need closer supervision and continuous heart rate monitoring. All patients should be encouraged to enrol in a formal cardiac rehabilitation program.

Some dos and don’ts for heart patients

Monitor for abnormal signs and symptoms, i.e. chest pain or high blood pressure, dizziness, and palpitations.
Always warm-up before and cool-down after exercising. This can be accomplished by performing the activity at a much lower intensity for the first 5 and last 5 minutes of exercise.
High-intensity exercise may precipitate cardiovascular complications, especially in patients who have suffered from a heart attack.
Patients with stable angina should always carry nitro-glycerine and be educated in its use.
Patients who have had open heart surgery should avoid resistance training exercises (other than their range of motion) that may cause pulling on the sternum (bone at the centre of the chest) within 3 months of surgery.
Heart rate guidelines may not be applicable to patients taking drugs, which slow down the heart rate, for example, Beta blockers. Therefore, consult your physician before starting any exercise regime. (Also read: Drink green tea for weight loss and to keep heart disease at bay!)

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Published: September 12, 2013 4:35 pm | Updated:April 1, 2015 12:34 pm

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