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After a heart attack, your heart may no longer be able to pump blood as efficiently as it once did. If treated within one hour of the heart attack's onset, the damage is likely to be minimized, and you may return to your daily activities. However, this serves as a warning sign that, without some lifestyle changes, you may face another heart attack or other complications. Researchers have found that exercise is one of the most significant factors in influencing heart disease. They also concluded that individuals who follow a specific exercise program after a heart attack have better outcomes, fewer hospitalizations, and no major illnesses in the subsequent year.
Steps
Preparing for Exercise
Consult your doctor. Make sure to get your doctor's approval before starting any exercise regimen. When the heart is damaged due to lack of oxygen, it requires several weeks to heal and return to its optimal state. You may need to undergo a stress test before leaving the hospital – this test will help your doctor determine the level of physical activity you can handle. Generally, there is no standard waiting period before you can begin exercising. Your doctor will provide a specific timeframe based on your current health, the severity of the heart damage, and your physical condition before the heart attack.
- Your doctor may advise against putting strain on your heart with exercise or sexual activity until it has fully recovered.
Recognize the importance of exercise. Exercise helps strengthen the heart muscle, improves oxygen absorption, lowers blood pressure, stabilizes blood sugar levels, reduces the risk of diabetes, and helps manage stress, weight, and lower cholesterol levels. All these factors contribute to reducing the risk of another heart attack. Begin your recovery journey with aerobic or cardiovascular exercises.
- Anaerobic exercises are high-intensity activities that trigger the formation of lactic acid, which can accumulate in the heart. These exercises are primarily used in sports that don’t require endurance to enhance strength, speed, and energy. After a heart attack, it is advisable to avoid this type of training.
- The anaerobic threshold is the boundary between aerobic and anaerobic activity. Endurance athletes train to raise this threshold, enabling them to compete at high intensities without lactic acid buildup.
Follow a cardiovascular rehabilitation program, if available. The recovery speed after a heart attack varies for each person. It is influenced by the extent of heart muscle damage and prior physical health. During cardiovascular rehabilitation, doctors monitor blood pressure and use an electrocardiogram to track exercise progress and prevent injuries. After completing a 6-12 week supervised rehabilitation program, you may be allowed to continue at home.
- Participants in medically supervised cardiovascular rehabilitation programs tend to recover faster and show better long-term results. However, only about 20% of patients qualify for the recommended rehabilitation or prescribed exercise programs post-heart attack. This number is even lower for women and older patients.
Learn to check your pulse. Take your pulse at the wrist rather than the neck (carotid artery). You may accidentally restrict the carotid artery when checking the pulse at the neck. Place your index and middle fingers (avoid the thumb, as it also has a pulse) of one hand on the opposite wrist, just below the thumb. You should typically feel the pulse. Count the beats you feel over 10 seconds, then multiply by six.
- It is important to monitor your heart’s pumping rate to keep your pulse within the range recommended by your doctor.
- This target will vary depending on age, weight, physical condition, and the extent of heart damage.
Discuss sexual activity with your doctor. Sexual activity is a form of physical exercise. In many cases, after a heart attack, your doctor may advise you to wait two to three weeks before engaging in intercourse. This time frame depends on the extent of heart damage and the results of stress tests.
- Your doctor will also determine whether you should wait longer than three weeks.
Start exercising
Stretch before exercising. With your doctor’s approval, you can begin regular stretching even while still in the hospital. Aim to stretch at least once daily to help prepare your body for exercise. Remember to relax and breathe throughout the process. To prevent injury, keep your joints slightly bent, never locking them. Avoid overloading your muscles; instead, gently stretch and hold for 10 to 30 seconds. Repeat three to four times.
- Stretching doesn’t enhance muscle strength or heart performance, but it does improve flexibility, making various exercises easier, while also enhancing balance and reducing muscle tension.
Start your exercise program with walking. Regardless of whether you were a marathon runner before your heart attack or had a long period of inactivity, your rehabilitation program will begin with walking. Start with a 3-minute warm-up, then gradually increase your pace to a level where your breath becomes heavier than when sitting, but you can still talk comfortably. Maintain this pace for about 5 minutes. Each day, add an extra minute or two until you reach 30 minutes of walking per day.
- In the first few weeks, walk with someone and stay close to home, in case you feel uncomfortable or short of breath. Always carry a mobile phone for help, or call emergency services if needed.
- Remember to relax after exercising.
Be cautious when increasing activity. Avoid strenuous activities for the first four to six weeks. Your heart needs about 6 weeks to fully recover enough for moderate to heavy exercises, even if your pre-heart attack health was good. Steer clear of activities like lifting heavy objects, vacuuming, scrubbing, sweeping, painting, running, mowing, or suddenly overexerting yourself. You can start with lighter tasks like walking on flat ground for a few minutes, cooking, washing dishes, shopping, gardening, or light household chores.
- Gradually increase exercise time and intensity without pushing yourself into anaerobic territory.
- Be aware that your arms and legs may feel sore a few hours or days after starting your exercise program. The soreness should not occur during the workout.
Increase exercise gradually. Just like starting your exercise program before the heart attack, you should gradually increase the duration and intensity of your workouts to reduce injury risk and maintain motivation. Don’t begin increasing time or intensity until your doctor clears you for walking over 30 minutes. It may take up to 12 weeks to walk comfortably at a fast pace for 30 minutes, depending on the extent of heart damage and your prior physical condition.
- Once you're comfortable with daily walking, you can introduce other forms of exercise, such as cycling, hiking, rowing, running, or playing tennis.
Check with your doctor before adding strength training. It’s likely that your doctor won’t recommend starting a strength training program right away.
- You can use hand weights at home or resistance bands attached to a door to perform exercises. Resistance bands can be used for both arms and legs, helping to gradually improve endurance and energy.
- Allow muscles time to recover between sessions by limiting strength training to no more than three times per week, with at least 48 hours before the next workout.
- Strength training will likely help you return to previous activity levels, such as mowing the lawn, playing with grandchildren, or carrying groceries. Strength exercises reduce the risk of becoming sedentary and losing muscle function.
- Don’t hold your breath when lifting weights or using resistance bands. This will increase pressure on the chest and make your heart work harder.
Stay active throughout the day. Once you’ve completed your workout, avoid staying seated all day. Studies show that even if you exercise for an hour each day, sitting for the next eight hours working or watching TV can negate all the benefits. Instead, enrich your day by standing up, stretching, or moving every 30 minutes. Stand to drink a glass of water, use the bathroom, stretch, or take a 5-minute walk. To encourage movement, you can also:
- Walk around or at least stand while talking on the phone.
- Place your water glass at the far end of the room to force yourself to stand up and drink every 30 minutes.
- Arrange your space to motivate you to get up and down throughout the day.
Pay attention to warning signs
Recognize signs that your heart may be overexerting itself. If you experience chest pain, nausea, dizziness, irregular heartbeats, or shortness of breath during exercise, stop immediately. The exercise may be causing your heart to work too hard. Call your doctor or emergency services if the symptoms don’t subside right away. Carry nitroglycerin while exercising if prescribed. You should also keep track of the symptoms, noting when they occurred during the day, after eating, how long they lasted, and how often they occurred.
- Discuss any other symptoms with your doctor before resuming exercise. Your doctor may want to conduct another stress test before allowing you to continue your workout program.
Avoid accidents and injuries. Wear the appropriate clothing and shoes for the type of exercise you're doing. Stay hydrated, and ensure someone knows where you’re going when you head out. Always use good judgment and don’t push yourself beyond your limits.
- It's better to exercise daily at a slightly lighter intensity than to have to rest for weeks due to an injury or readmission for heart-related issues.
Avoid exercising outdoors in extreme temperatures. In very hot or cold weather, your body has to work much harder to deliver oxygen to your cells, including the heart. Don’t exercise outside if the temperature is below 1.7°C or above 29.5°C, and humidity is above 80%.
Advice
- Stay hydrated during exercise. Whether you're outdoors or in a gym, carry water and drink regularly. Dehydration causes the blood to become more “sticky,” and the heart has to work harder to pump it throughout the body.
- Practice checking your pulse on your wrist beforehand to make it easier during exercise.
Warnings
- Stop immediately if you experience chest pain, fatigue, nausea, or difficulty breathing beyond what is typical for the exercise you’re doing. Cease the workout and monitor your symptoms. If they don’t resolve within three to five minutes, seek medical attention immediately.
- Avoid extreme weather conditions. Both excessive heat and cold can increase the strain on the heart. Avoid exercising under direct sunlight if temperatures exceed 29°C, unless the humidity is extremely low. Also, steer clear of exercising in cold weather with strong winds, especially when temperatures reach -18°C or lower.
