How do I start exercising again after a heart attack or heart surgery?

A patient attending his cardiac rehab

It’s good to stay active after a heart event, but where do you start? Sarah Brealey shares tips from three cardiac rehabilitation experts.

When you’ve had a heart event, it’s natural to wonder if it’s safe to exercise any more, but being active can strengthen your heart and aid recovery. It’s vital to get the right support though. Attend cardiac rehabilitation sessions, if possible; ask your doctor if you haven’t received an invitation after a few weeks. We asked cardiac rehab professionals at Salford Royal NHS Foundation Trust (the BHF Alliance Team of the Year 2015 a few questions about those vital first steps:

How do I start getting active after a heart event?

Lisa Docherty, Highly Specialist Cardiovascular Rehabilitation Nurse: Gentle walking is the best way to start, even if it’s just for two minutes. Do what you can manage. Do it every day until it feels easier, then increase the time, and later the speed.

Aim to be exercising for 15–20 minutes at a time by weeks four to six. By this time you should also have started attending cardiac rehabilitation sessions.

We try to set goals that are specific to the patient and achievable

Which types of exercise are best?

Stefan Birkett, Exercise Specialist with expertise in exercise testing and research: Walking costs nothing. You can do it at a level to suit you, and it can build up your fitness before you start rehab. After that, the choice of exercise is up to you, as long as your health professional agrees.

But I’ve always done cycling/tennis/football –  can’t I do this instead?

Eddie Caldow, Exercise Physiologist: We would recommend waiting a few weeks, until you’ve started cardiac rehabilitation and can be assessed by a professional. If you have had prompt treatment after a heart attack, you may quickly feel better physically and want to get back to whatever you used to do, but it is still best to let the heart recover.

We wouldn’t recommend doing any sport without seeking the advice of a professional first.

I can’t walk because of my arthritis/balance problems. What can I do?

EC: For people who can’t walk much, swimming or aqua aerobics can be very beneficial. It is low weight-bearing and doesn’t put much strain on the joints. But check with your specialist first.

How do I know if I am pushing myself too hard?

SB: At cardiac rehab, we explain the Rate of Perceived Exertion scale, where you judge how hard you’re working, based on factors such as how heavy your breathing is and how easy it is to talk.

This helps you to exercise at the right level. It’s fine to be a little bit short of breath, but not so breathless you can’t talk. Chest tightness, dizziness, palpitations and shortness of breath are warning signs. If you experience these, stop and seek medical advice.

We’ve never exercised in my life. Why would I start now?

LD: Some of our patients haven’t exercised for a long time, but when they start cardiac rehab they discover it’s something they enjoy. And it can benefit your heart health.

But I don’t like gyms and can’t use the equipment.

Do what you can manage. Do it every day until it feels easier

LD: Cardiac rehab centres have fully equipped gyms, and for the first few classes we give one-to-one support, showing how the machines work and helping people understand why they are doing what they are doing.

That helps to build confidence. But there are lots of other ways to keep active, too.

How can I motivate myself to exercise?

EC: We recommend setting weekly goals, then tracking progress using a pedometer or by measuring how far you walk or for how long. We try to set goals that are specific to the patient and achievable for them, whether it is walking with friends or family, getting back to running, or gardening.

I’m quite fit already; I don’t think cardiac rehab is for me.

EC: It can be perceived as a low-level exercise class, for people who can’t do very much. But modern cardiac rehab is about pushing people to their full potential and getting them back to work, or to where they want to be.

I’m frightened to exercise in case my chest pain returns.

EC: It’s normal to worry about returning to exercise. We tell people that they’re not alone in this, which can be really helpful. Being in a group environment is supportive and if anyone needs further psychological support, we can put them in touch with people who can help.

What can I do when?

Everyone’s recovery is different, so check with your doctor or cardiac rehab team before returning to or taking up exercise. You may find that you will need longer than we’ve suggested below to recover, but here is a typical timeline:

Time following heart attack

Time following heart surgery

When you feel ready
Walking, cycling on a stationary bike, sexual activity  
When you feel ready
Walking, cycling on a stationary bike
1 week

Making light snacks, pottering round the house and garden, peeling vegetables while sitting

1-4 weeks

Housework, such as hanging out washing, tidying, dusting, with rests. Light gardening, such as potting. Sexual activity (but don’t use your arms to support yourself)

2 weeks
Light housework, such as making beds, washing up and preparing simple meals 4-6 weeks Golf – walking the course and putting, not the full swing
3-4 weeks
Housework, such as hanging out washing, tidying, dusting, with rests. Carrying shopping bags or pulling a shopping trolley. Light gardening, such as gentle weeding or potting 8 weeks
Bowls, dancing
5-6 weeks

Vacuuming, ironing, moderate gardening (mowing the lawn, light hoeing)

10-12 weeks
Swimming, road cycling
7-8 weeks
DIY, lifting 12 weeks
Racket sports, fishing, golf with full swing, lifting children, vacuuming, mowing the lawn, digging, pushing supermarket trolleys, carrying shopping. Your breastbone and the muscles in your chest take time to heal, so do not do lifting or heavy arm activity in the first 12 weeks as it could delay the healing process

Getting active

Even if you don’t have a heart condition, physical activity can reduce your risk of heart disease. It can also help you control your weight, reduce blood pressure and cholesterol, and improve mental health.

More useful information