Exercising when you have a heart condition

You just discovered you need surgery to replace a faulty heart valve. Or maybe you've had a heart attack, or were recently diagnosed with mild heart failure. Learning that you have heart disease is understandably upsetting. But don't let fear or worry keep you from taking steps to heal and strengthen your heart.

"For a lot of people, a heart attack is a wake-up call. But for others, it's more like a red light," says Dr. Hicham Skali, associate director of the cardiac rehabilitation program at Harvard-affiliated Brigham and Women's Hospital. Instead of starting or renewing efforts to exercise, they stop or avoid physical activity. "Some people believe that a heart condition means they should be careful and rest, but that's a major misconception," says Dr. Skali.

Exercise is one of the most important things you can do to prevent all types of heart disease from getting worse — not to mention avoiding heart problems in the first place. "As long as you're exercising safely, there's far more benefit than risk," says Dr. Skali. Your age, current fitness level, and diagnosis will influence what makes the most sense for you. But everyone can exercise, and even small amounts can make a difference, he adds.

Cardiac rehab

Many people with heart disease qualify for cardiac rehabilitation. The initial evaluation includes an exercise stress test, a closely monitored workout done on a treadmill or stationary bike that shows how your heart and body respond to exertion. The results can help your rehab team offer safe, effective suggestions for physical activity.

Unfortunately, not everyone who qualifies for cardiac rehab has easy access to such a program, which typically requires you to attend a few times a week for several months. However, a hybrid program that includes some online sessions may be available (see "A virtual approach to healing the heart" in the October 2022 Heart Letter).

Another option is to ask your cardiac surgeon, cardiologist, or primary care doctor to prescribe an exercise stress test, which can be reassuring for people who are worried about exercising, says Dr. Skali. If you're generally healthy, your doctor might decide that you don't need a stress test and can go ahead and start exercising on your own.

After a procedure

After any procedure, wait until your doctor gives you the green light to start exercising. After an angioplasty (a minimally invasive procedure to widen a narrowed or blocked heart artery), you can usually resume your normal activities after two days. If you had the procedure to treat a heart attack, you might need to take it easy for a bit longer. People often need a month or more to fully recover from open heart surgery, which requires sawing through the breastbone. But that doesn't mean avoiding exercise as you heal. In fact, a small study found that starting cardiac rehab just two weeks after surgery was just as effective and likely as safe as waiting for six weeks, says Dr. Skali.

The good news is that people often have more energy and endurance after their heart is repaired. Take it easy at first, starting "low and slow," especially if exercise hasn't been part of your regular routine, says Dr. Skali. Walking outside or on a treadmill for just five minutes at a time several times a day is a good way to start. Keep adding a few minutes to your walks every week or so, until you're up to at least 20 minutes a day. Pay attention to how you're feeling, and add intensity by walking briskly (or even jogging) for short bouts if that feels okay.

Rest as needed

Even people who've never exercised and have several serious health problems can still exercise. "I have patients with heart failure and obesity who tell me they can't walk for more than one minute," Dr. Skali says.

His advice: Put a chair at each end of your driveway or whatever short distance you can manage. Walk back and forth between the chairs, sitting down to rest when needed to catch your breath. Try to do four laps in the morning, and then another four laps in the afternoon. "Even just 30 seconds at a time is enough to make progress," he says. And no matter what your fitness level, always stop or slow down if you feel dizzy, weak, or breathless.

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