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There is plenty of evidence supporting the benefits of physical activity following a heart attack

Regular physical activity can benefit all people with heart disease or other stable heart conditions. These benefits include:

  • making it easier to do normal daily activities
  • improving your quality of life
  • increasing your fitness level
  • helping to improve heart disease risk factors (high blood pressure, high cholesterol, diabetes)
  • lowering your risk of further heart problems, hospital admissions and death

Your heart has many protective mechanisms to help it recover. However, it is important to take things slowly initially and not over do it as your heart has undergone a lot of stress, and may not yet be functioning as well as before your heart attack.

An entertaining and informative visual lecture about the single best thing you can do for your health -- exercise!
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Did you know?

Exercise does not only help to improve heart health, it also helps to lower the effects of stress and risk of depression and anxiety.

The hardest thing about getting fit is getting past the letterbox. If you have had a heart attack all you need to do to start with is to get out of your house and walk past your letterbox. If you can get past your letterbox and walk 3 minutes one way and 3 minutes the other you are on your way to fitness. That's as simple as it gets.Graham Lowe
Graham Lowe
What should I do in the first days and weeks of leaving hospital?
The first week or two following any sort of heart event should involve short bouts of physical activity. During this time your goal should be to do small bouts of physical activity for a total of 5 to 15 minutes a day. This may be a slow walk to the letterbox, several times a day.

As a guide for how hard you should exercise, the exercise should feel ‘light’ and you should stop if you feel tired. Accumulating five to 15 minutes of physical activity over a number of bouts in a day is just as effective as doing it all at once, so don’t feel you are ‘cheating’ by doing five three-minute walks. This is a safe and equally effective way of exercising.

After a couple of weeks, as you become stronger, your energy levels will increase and you can return to normal daily activities. It is important to plan how you can slowly increase the duration and intensity of what you are doing. To give you some ideas, physical activity can include everyday things like gardening, washing the car, or walking up stairs.

What if I've had open heart surgery?
If you have had open heart surgery (coronary artery bypass graft), upper body exercise should be limited while the wound heals and only commenced after talking to your doctor or health provider. In the meantime, you can do some lower body exercise such as:

  • Walking
  • Cycling
  • Stair climbing
  • Water walking, although if you have had open heart surgery you should avoid this until you have spoken with your doctor or health provider.

You may start by walking to the corner of your street and then slowly increase the distance by going to the next block or walking completely round the block. For those living in a rural area, it may be as simple as increasing the number of power poles you walk to.

After four to six weeks of exercising regularly without any abnormal signs or symptoms, the aim should be to work toward continuous exercise. For example, if you have been doing four to five chunks of exercise, try to do two to three a day to get to your 30 minutes a day, and if you can do that aim for one to two bouts.

How can I increase my confidence to exercise?
One of the most common issues for those going through cardiac rehabilitation is developing the confidence to exercise again. Before starting any sort of physical activity or exercise after a heart attack, it is important you discuss your condition and what physical activity you can expect to do with your doctor or health professional.

One of the most effective ways of increasing your confidence to exercise is to join a supervised phase two cardiac rehabilitation programme. These can be found across the country and are free of charge if run through your local district health board. Check out the HeartHelp Directory for a phase two programme in your area.

If you are unable to attend a programme, you should take small steps to build your confidence to exercise. You may only do five to 10 minutes of walking around the house, but if you can do this without a problem, look to increase this by a minute the next day and so on. You may like to ask your doctor for a ‘Green Prescription’ – visit the Ministry of Health website for more information on these – What is a green prescription?.

Having a support person such as a family member or friend to exercise with you can be great for confidence as well as a great motivator.

It is very important to take steps to improve your confidence to exercise. Starting regular aerobic exercise such as walking, swimming, or cycling is a crucial part of long-term treatment for most people with heart disease. You may find it useful to look at the HeartHelp Directory for local exercise groups, or check out Sport New Zealand.

What if I develop angina when I'm exercising?
Following a heart attack, some people may still experience episodes of angina during physical activity and this can affect their confidence to exercise. If you experience angina it is important that you recognise it and know what to do. You must stop and follow the chest pain/angina action plan. You should also discuss this with your doctor and ensure that you carry your medication to treat episodes of angina if your doctor has prescribed this.
What if I get short of breath?
If you have problems breathing or feeling short of breath when exercising, it may be an indication that your heart cannot cope with the intensity of your exercise. Dyspnea is the medical term for shortness of breath. The dyspnea rating scale will help you assess your breathing during exercise.

Your level of shortness of breath (dyspnea) will depend on your current health and your heart history. You should discuss your degree of dyspnea with your doctor or health professional to ensure you are doing the most appropriate level of exercise but as a general rule you should aim to keep your dyspnea level lower than a level 3.

Contact your doctor or health professional if you experience any abnormal shortness of breath.

Goal setting

A great way to help motivate you to be physically active following a heart attack is to set yourself some goals. These should be SMART GOALS, which means they should be Specific, Measurable, Achievable, Realistic and Time bound.

An example of a SMART goal is: “I want to be physically active for for at least 30 minutes per day, four days a week for the next 10 weeks.”

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Frequently asked questions

How do I monitor my level of exercise?
Most people after a cardiac event will be on medication which can affect their heart rate. A great and easy way to monitor the intensity or level of exercise is by using the RPE chart below. For the first week or two, when you ask yourself “how hard is this exercise?”, you should be able to say that you are exercising at a ‘light’ intensity or level, meaning you can tolerate or continue with that level of exercise for a good period of time and still maintain a conversation.

As you progress and feel more confident about exercising and have no abnormal symptoms, you should aim for a ‘moderate’ level, meaning your breathing is increased, but you can still carry on a conversation without difficulty. If you are struggling to speak, this means the exercise is too hard and you should reduce the level immediately.

If you feel any of the following symptoms, STOP the activity and follow your angina action plan: Chest discomfort or pain, breathless on minimal exertion, excessive sweating, clammy skin, faint, nauseous, rapid or weak pulse, or any other pain or significant discomfort.

Since my heart event or heart surgery, I have lost a lot of upper and lower body strength, how can I regain this?
Firstly if you have had open heart surgery you should wait at least 12 weeks before performing upper body exercise, and seek approval from a health professional before starting. Initially, the goal should be on movement and just moving the body rather than focus on moving weight itself. For example:

Upper body exercises (once you have approval from your doctor or other health professional)

  • Start by holding a can of food or bottle of milk in each hand and with your arm straight and the palm of your hand facing forward, slowly bend your elbow, bringing the palm up toward shoulder; you should feel this in your upper arm. Gently lower down to starting position. The goal is to progress this to 8-12 repetitions on each side. If you get tired it is fine to take a break
  • You may also like to try front and lateral raises; this involves keeping your arm straight at all times, and raising the can/bottle directly out in front of you, then lowering it back to the starting position
  • Lateral raises are similar, but you are raising your arms out to the side to shoulder height, instead to out in front.

Lower body exercises (aim to progress toward 8-12 of these at a time)

  • Step up onto a step and then back down again, repeat
  • Get up from a chair without using your hands (if possible) and sitting down again
  • Rising up on the tips of your toes and down slowly.
What are some things that will make exercise easier for me?
The first and biggest thing you should do prior to starting exercise is check with your health professional about what it is safe for you to do.

  • Start with a five-minute warm-up at a very light level and if exercising in cold weather, it should be longer. This will help prepare your body for exercise. For example, if you are planning on going for a 30-minute walk, walk slower and on flat ground (i.e., avoid hills during your warm up) during the first five minutes or so, to avoid a rapid increase in heart rate
  • It is also important to warm-down after exercise, this may involve some very light exercise such as stretching, yoga or tai-chi
  • Keep yourself hydrated during exercise. It is ideal to have a bottle of water handy and drink regularly throughout exercise. Water is the perfect form of hydration. Sports drinks are full of unnecessary sugar and may cause you to gain weight and affect blood glucose control, in particular for diabetics.
Exercise causes pain in my joints, what should I do?
If you have a joint condition such as arthritis, avoiding exercise is one of the worst things you can do. When you exercise and move the joint, you are using the muscles around the joint. These muscles help to support the joint, and reduce the workload on the joint itself. If you don’t use these muscles, with ageing they will reduce in size and strength, generally making the condition worse.

The best type of exercise for people with joint discomfort is non-weight bearing, low impact such as swimming and cycling. Even the resistance from walking in water can be beneficial for your heart. Low impact exercises such as tai-chi or yoga are also great ways of keeping your muscles and joints active, whilst benefiting your heart health.

Atrial fibrillation (AF) and exercise

You may be afraid to exercise with atrial fibrillation, but you needn’t be, as long as you do so safely. Here are some tips to help prevent your heart rate from going too high when exercising, and help you to recover more quickly after exercise:

  • Start with a slow and gradual five-minute warm up as well as finish with a five-minute cool down
  • Drink a good amount of water when you are exercising.

Internal cardiac defibrillator and exercise

If you’ve had an internal cardiac defibrillator fitted, avoid upper body exercises for at least 12 weeks, until a health professional has given you the OK.

Upper body exercises may dislodge the wires placed in your heart. Know what limits are set for your device and avoid high intensity exercise that may increase your heart rate towards these limits.

You can monitor your heart rate during exercise by measuring your pulse or using a heart rate monitor. Additionally, drinking plenty of water during exercise may prevent your heart rate from getting too high.

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