Easing back into exercise after a heart event

Stephen on his bike

With a heart problem it can be hard to know how much to do when it comes to exercise. Senior Cardiac Nurse Philippa Hobson advises how to push yourself safely.

Exercising after a heart attack or surgery may seem like a daunting prospect, but for most people it’s one of the best things you can do to help you get your fitness back and reduce your risk of further heart problems.

Last year, Stephen McKeown cycled 1,000 miles. The 53-year-old supermarket worker, from County Down, Northern Ireland, was a keen cyclist, covering up to 200 miles a week before discovering he had three narrowed coronary arteries (one of which was 90 per cent blocked) and had even had a heart attack without realising. He needed bypass surgery.

Three years later, stents were fitted after two of the grafts from the surgery became blocked. After both procedures, Stephen managed to get back to cycling and is an avid cyclist once more. In June this year, for the Young Hearts charity tour, he covered more than 800 miles in just nine days.

Easing back into exercise

It’s really important you don’t rush or have unrealistic expectations of yourself while you recover. Don’t overdo it, as you might end up feeling worse, delay your recovery and lose newly built confidence.

Stephen eased back into exercise by simply walking. This is the best way to get active again after surgery or another heart event.

Stephen walking in nature

Starting small is best – Stephen built up from just 50 metres in the first few days to five miles after a few months. But is returning to exercise so soon a good – and safe – idea?

According to Iain Waite, Senior Cardiac Physiotherapist at King’s College Hospital in London, yes. “Patients are advised to start physical activity as soon as they are discharged from hospital, but it’s equally important that they’re ready to do so,” he advises.

“Start slowly. Then gradually build up the frequency, intensity and duration over time.”

A good starting point is being active around the house – as soon as you can – and then start going for short walks, even if just for a few minutes.

Setting small reachable goals, such as next door’s gate, a tree or a nearby postbox, helps to measure your progress and gives you something to build on.

Attending cardiac rehabilitation is the safest and most effective way to know how hard you can push yourself. Don’t be put off by thinking you won’t be able to keep up with everyone (or the reverse – that you’ll be fitter than everyone).

You’ll be assessed at the start so that an exercise programme can be tailored to you, and will be supported by a team of specialists who will help you exercise safely and monitor your progress.

Stephen tending to his bike

Stephen’s ultimate goal was to get back on the bike, so about four months after his surgery, he went for a short ride. “Three miles was my absolute limit that day, but that didn’t matter,” he remembers. “The wheels were turning again.”

It was this positive outlook from the start that Stephen believes really helped.

How much should you push yourself?

Moderate-intensity aerobic exercise is normally advised. “This means aiming to work at 40 to 70 per cent of your target heart rate, or 11 to 14 using the Borg rating,” explains Mr Waite.

The Borg rating of perceived exertion (RPE) scale measures how hard you’re pushing yourself. It runs from six to 20 (six is no exertion and 20 is pushing so hard that you couldn’t keep it up for long); 11 to 14 runs from ‘fairly light’ to ‘somewhat hard’, whereby your heart rate and breathing should be a bit faster, without making you out of breath.

A general rule of thumb is to exercise at a level where you’re still able to hold a conversation but feel warm and slightly breathless. This way your heart gets the benefits of exercise without the small increase in risk that can come from vigorous activity.

Stephen with his dog

You might be used to exercising at a more strenuous level, and if you have made a good recovery from your heart attack or surgery, it is usually possible to go back to everything you used to do – but make sure you check with your cardiac rehab specialist or other health professional first.

It’s particularly important to take advice from your specialist if you are new to exercise, have heart failure or joint or muscle problems. You will need to work at a lower intensity, but you will still benefit.

If you have peripheral arterial disease (circulation problems in your lower limbs), you may get pain in your calves when you walk, but it’s still really important to exercise as this is one of the best ways of managing your condition.

Very strenuous or competitive exercise is usually not recommended for people with inherited heart conditions associated with dangerous heart rhythms. Whether your exercise is moderate or strenuous, it is really important to warm up and cool down properly.

How to monitor your heart rate

Stephen had a faster recovery from his stents procedure than the earlier bypass surgery (apart from some tenderness in his groin area, where the doctors had passed the catheter up to his heart), so was able to get back to cycling more quickly second time around.

Stephen looking at his digital watch

As well as monitoring his RPE, Stephen also kept an eye on his heart rate and knew the levels he should be aiming for. He now finds it helpful to wear a heart rate monitor while cycling.

“This allows me to keep track of my heart rate and make sure I’m staying within a safe level.”

Many people like to track their progress and their fitness level by using a variety of wearable monitors and apps, but it isn’t essential to monitor your heart rate in order to exercise safely – you can use the RPE described above instead. Some people do find it helpful, while others can spend a lot of time worrying about it. Remember, the way you are feeling is usually the best guide.

What are the signs of doing too much?

If you have difficulty breathing, develop chest pain or become light-headed and dizzy, you need to slow down and stop. Feeling fatigued and sick are also signs you might have done too much too quickly. Seek advice from your GP or specialist if this happens to you.

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