Fitness: Exercises for a Healthy Heart and Tips

Do this 30-minute workout routine every other day, or do it two days in a row if that's better for your schedule.

A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it's a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system.
• Improve your circulation and help your body use oxygen better.
• Improve your heart failure symptoms.
• Increase energy levels so you can do more activities without becoming tired or short of breath.
• Increase endurance.
• Lower blood pressure.
• Improve muscle tone and strength.
• Improve balance and joint flexibility.
• Strengthen bones.
• Help reduce body fat and help you reach a healthy weight.
• Help reduce stress, tension, anxiety, and depression.
• Boost self-image and self-esteem.
• Improve sleep.
• Make you feel more relaxed and rested.
• Make you look fit and feel healthy.

How Do I Get Started?

Before starting an exercise program, talk to your doctor about:

• Medication changes. New medications can greatly affect your response to exercise; your doctor can tell you if your normal exercise routine is still safe.
• Heavy lifting. Make sure that lifting or pushing heavy objects and chores such as raking, shoveling, mowing, or scrubbing aren't off limits. Chores around the house can be tiring for some people; make sure you only do what you are able to do without getting tired.
• Safe exercises. Get the doctor's approval before you lift weights, use a weight machine, jog, or swim.

What Type of Exercise Is Best?

Muscle loss is one of the main reasons people feel less energetic as they get older. When you lift weights, work out on machines, use resistance bands, or do exercises with your own bodyweight (like push-ups and sit-ups), you build strength, muscle mass, and flexibility.

Exercise can be divided into three basic types:

• Stretching: slow lengthening of the muscles. Stretching the arms and legs before and after exercising helps prepare the muscles for activity and helps prevent injury and muscle strain. Regular stretching also increases your range of motion and flexibility.
• Cardiovascular or aerobic: steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing.
• Strengthening: repeated muscle contractions (tightening) until the muscle becomes tired. For people with heart failure, many strengthening exercises are not recommended. (See below)

• Aerobic exercises include: walking, jogging, jumping rope, bicycling (stationary or outdoor), cross-country skiing, skating, rowing, and low-impact aerobics or water aerobics.

How Often Should I Exercise For A Healthy Heart?

Exercise will relieve stress, boost your brainpower, better sleep, and diet.

In general, to achieve maximum benefits, you should gradually work up to an aerobic session lasting 20 to 30 minutes, at least three to four times a week. Exercising every other day will help you keep a regular aerobic exercise schedule.

What Should I Include in My Program?

Every exercise session should include a warm-up, conditioning phase, and a cool-down.

• Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate), and body temperature. It also helps improve flexibility and reduce muscle soreness. The best warm-up includes stretching, range of motion activities, and the beginning of the activity at a low-intensity level.
• Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. Be sure to monitor the intensity of the activity (check your heart rate). Don't overdo it.
• Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean to sit down! In fact, do not sit, stand still, or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity. You may also do some of the same stretching activities you did in the warm-up phase.

What Is the Rated Perceived Exertion Scale?

The Rated Perceived Exertion (RPE) scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) would be how you feel at the end of an exercise stress test or after a very difficult activity.

0
Nothing at all

0.5
Just noticeable

1
Very light

2
Light

3
Moderate

4
Somewhat heavy

5-6
Heavy

7-9
Very heavy

10
Very, very heavy

In most cases, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

What is heart failure?
See Answer

What Are Some Warm-Up Exercises?

Partial crunches build strength in both your lower back and related stomach muscles, making this an ideal exercise for people with spondylosis.

Every exercise session should start with a warm-up. Here are some stretching exercises you can try to get yourself started. Please check with your doctor before starting any exercise program. If any of the following exercises causes pain, do not continue the activity and seek the advice of a doctor or physical therapist.

Exercise while sitting

While performing these exercises, maintain good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises.

• Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.
• Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.
• Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)
• Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.
• Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.
• Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.
• Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.
• Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.
• Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

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Stretching exercises

Hamstring stretches relieve the back of the leg, where some of the muscles that support the work of the lower spine are found.

While performing these exercises, make sure your movements are controlled and slow. Avoid quick, jerking movements. Stretch until a gentle pull is felt in your muscle. Hold each stretch without bouncing or causing pain for 20 to 30 seconds. Do not hold your breath during these exercises.

• Hamstring stretch. While standing, place one foot on a stool or chair, while holding onto a wall or sturdy object (such as a table). Choose a comfortable height that allows you to keep your knee straight. Slowly lean forward, keeping your back straight, and reach one hand down your shin until you feel a stretch in the back of your thigh. Relax, and then repeat with your other leg.
• Quadriceps stretch. Stand facing a wall, placing one hand against the wall for support. Bend one knee, grasping your ankle, and pulling your leg behind you. Try to touch your heel to your buttocks. Relax, and then repeat with your other leg.
• Calf stretch against the wall. Stand facing the wall with your hands against the wall for support. Put one foot about 12 inches in front of the other. Bend your front knee, and keep your other leg straight. (Keep both heels on the floor.) To prevent injury, do not let your bent knee extend forward past your toes. Slowly lean forward until you feel a mild stretch in the calf of your straight leg. Relax, and then repeat with your other leg.
• Calf stretch on stairs. Stand on the stairs, holding a handrail or placing your hand on the wall for support. Place the ball of one foot on the stair. Lower your heel down toward the step below, until you feel a gentle pull in your calf. Switch legs.
• Knee pull. Lie on your back and flatten the small of your back onto the floor. Bend one knee and pull your bent leg toward your chest, until you feel a pull in your lower back. Try to keep your head on the floor, but do not strain yourself. Gently lower your leg, and then repeat with your other leg.
• Groin stretch. Lie on your back with your knees bent and the soles of your feet together. Slowly lower your knees to the floor until you feel a gentle pull in your groin and inner thighs.
• Overhead arm pulls. Lock your fingers together, with your palms facing out (or hold onto a towel so your hands are shoulder-width apart). Extend your arms out in front of you with your elbows straight. Lift your arms to shoulder height. Raise your arms overhead until you feel a gentle pull in your chest or shoulders.
• Behind back arm raise. At waist level, put your hands behind your back, locking your fingers together (or hold onto a towel so your hands are shoulder-width apart). Straighten your elbows and raise your arms upward until you feel a gentle pull in your chest or shoulders.
• Side bends. Stand straight with your legs about shoulder-width apart. Reach over your head with one arm, elbow bent, sliding the opposite arm and hand down your thigh, toward your knee. Hold the stretch until you feel a gentle pull at your side. Repeat with another side.
• Double shoulder circles. While bending your elbows, put your fingertips on your shoulders. Rotate your shoulders and elbows clockwise, then counter-clockwise, as if drawing large circles with both elbows. Repeat in each direction.
• Leg circles. Hold onto a chair or other sturdy object for balance. Lift one leg straight behind you, keeping both knees straight. Rotate your leg clockwise, then counter-clockwise, as if drawing small circles with your foot. (You should feel the movement at your hip joint). Repeat in each direction, with each leg.

How Can I Avoid Over Doing It?

Here are a few guidelines:

• Gradually increase your activity level, especially if you have not been exercising regularly.
• Wait at least one and a half hours after eating a meal before exercising.
• When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
• Take time to include a five-minute warm-up, including stretching exercises, before any aerobic activity and include a five- to 10-minute cool down after the activity. Stretching can be done while standing or sitting.
• Exercise at a steady pace. Keep a pace that allows you to still talk during the activity.
• Keep an exercise record.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. You'll be more likely to stick with an exercise program if you enjoy the activity. Here are some questions you can think about before choosing a routine:
• What physical activities do I enjoy?
• Do I prefer group or individual activities?
• What programs best fit my schedule?
• Do I have physical conditions that limit my choice of exercise?
• What goals do I have in mind? (For example, losing weight, strengthening muscles or improving flexibility.)
• Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

General Workout Tips for People With Heart Failure

• Be sure any exercise is paced and balanced with rest.
• Avoid isometric exercises such as push-ups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Don't exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly; extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities such as mall walking.
• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But, be careful not to drink too much water. Follow your doctor's guidelines about how much fluid you can have in a day.
• Extremely hot and cold showers or sauna baths should be avoided after exercise. These extreme temperatures increase the workload on the heart.
• Steer clear of exercise in hilly areas. If you must walk in steep areas, make sure you slowdown when going uphill to avoid working too hard. Monitor your heart rate closely.
• If your exercise program has been interrupted for a few days (for example, due to illness, vacation, or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

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Exercise Precautions For A Heart Healthy Exercise Program

There are many precautions you must keep in mind when developing an exercise program. Here are some tips.

• Stop the exercise if you become overly fatigued or short of breath; discuss the symptoms with you doctor or schedule an appointment for evaluation.
• Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
• If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
• Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it's still above 120-150 beats per minute, call the doctor for further instructions.

If you experience pain:

• Don't ignore it. If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints.

Stop the exercise and rest if you:

• Have chest pain
• Feel weak
• Are dizzy or lightheaded
• Have unexplained weight gain or swelling (call the doctor right away)
• Have pressure or pain in the chest, neck, arm, jaw, or shoulder
• Have any other symptoms that cause concern

Call the doctor if you have symptoms that do not go away.

Reviewed by the doctors at the The Cleveland Clinic Heart Center.

Edited by Charlotte E. Grayson, MD, June 2004, WebMD.

Portions of this page © The Cleveland Clinic 2000-2004