Don’t Let a Heart Condition Keep You From Exercise

Don’t Let a Heart Condition Keep You From Exercise

The fact is, the post-ride heart attack scene is incredibly misleading. Regular exercise or movement is one of the best things we can do for our bodies, and that’s especially true for people who have or are at risk of heart disease, according to the cardiologist Melissa Tracy, MD, who serves as an associate professor of medicine and the medical director for cardiac rehabilitation at Rush University Medical Center in Chicago.

Dr. Tracy works with patients on both primary and secondary prevention of heart disease, and exercise is a huge component of that treatment. Primary prevention means working with patients who have risk factors — like obesity, hypertension, high cholesterol, diabetes, metabolic syndrome, smoking, and family history of heart conditions — but who have not yet had a cardiac event. Secondary prevention, on the other hand, means working with patients who’ve already experienced a heart attack, bypass or valve surgery, or heart failure.

Whether the concern is primary or secondary prevention, when helping patients begin a new movement practice, Tracy asks the same questions:

With these answers in mind, Tracy can help her patient put together a plan. An activity that someone doesn't enjoy, for example, would only set them up for failure. It's also essential to have a clear sense of how much time someone can commit to movement.

“For patients who have limited time, I will get them to focus on setting a schedule for themselves, which days of the week they can work exercise into their lifestyle.” And then Tracy will explain the importance of beginning slowly. “That is the key: to start slow and gradually work yourself up,” she says.

If patients quickly throw themselves into an intense workout regimen, which people often do, especially around New Year's, they risk burning out quickly or even injuring themselves, neither of which encourages a lasting habit.

For people beginning a new movement practice, Tracy recommends three to four 20-minute sessions of continuous aerobic motion per week. And she’s quick to point out that “you do not have to work your heart rate up into very high levels of intensity in order to get a benefit from exercise.”

Within that 20 minutes, the first five should be a warm-up. She recommends patients keep in mind the idea of “perceived exertion”: how hard it feels like your body is working on a scale of 1 to 10.

If sitting or standing around chatting with a friend is level 1, a warm-up should move your perceived exertion to a level of 3 to 4. “It’s where my breathing is still rather controlled, conversation is still rather controlled. I can tell I’m moving, it’s getting a little bit more difficult, but I’m still very comfortable.”

The next 10 minutes should shift into the 5 to 7 range, she says. “Breathing becomes a little more labored, conversation can become more difficult, but they’re not at the point where they can’t [talk],” Tracy explains. In that 10 minutes, you should be focusing on your breathing, focusing on your form, and making sure you can sustain the activity comfortably for at least 10 minutes.

A five-minute cooldown is also essential. “I don't want patients to ever stop exercising immediately. Because what happens then is the blood pools into their legs, and that's where patients can become light-headed, nauseated, and just not feel good,” Tracy says.

The activity Tracy recommends will depend on individual preference, but walking is always a great starting point, since it doesn’t require any special equipment, and you can even do it around the house. Stairs are great to incorporate if you’ve got them.

To illustrate just how easy 20 minutes of movement can be, Tracy suggest the following: Warm up for five minutes by walking with your arms by your sides, and gradually increase your pace. When you begin your 10 minutes of moderate exertion, “that’s when I want them to focus on moving their arms. And anytime you move your arms, especially if you move your arms above the level of your heart, you’re going to have your heart rate increase,” she says, which should make you feel warmer and maybe even start to sweat.

But remember, it shouldn’t hurt. “Exercise should be something that's pleasurable, where you feel that you're working your muscles, but there should not be pain.” For your cooldown, you can keep moving your arms, but don’t bring them above the heart anymore, which will help gradually bring your heart rate back down.

If you’re living with joint issues, biking is a great alternative. For those who prefer to stay inside, Tracy finds that stationary bikes are less intimidating than treadmills — but you need to keep them in rooms where you spend the most time, like the kitchen or living room. “Put it where you’re going to use it,” Tracy says. “A lot of people will put their exercise equipment in their bedroom, and it just becomes a clothes rack.” If biking isn’t your thing, swimming is another good option for people with joint complaints.

It’s no surprise that for many of us, exercise can feel like quite a chore. But if this is true for you, Tracy suggests a simple perspective shift: “Embrace exercise as if it’s a shower,” something you do daily that feels refreshing and makes your body feel good. “That should be how you embrace movement. Don’t call it exercise” if that word turns you off, she says.

And think about how great you’re going to feel afterward. After Tracy goes for a run, for instance, she knows she will feel completely energized, “like I can conquer so much. My mind is clear. I sweat out impurities. My muscles are nice and warm. I am ready.”

Exercising with another person or in a group can jump-start your motivation, too — one reason why Tracy sometimes recommends dancing, even for people with two left feet. Variety in your movements can stave off boredom as well. If you’ve made a promise to another person, whether it’s to dance or even go for a walk together, you’re more likely to follow through with your planned activity, and you can lean on your companions for motivation on days when you don't wake up with any.

For patients who are comfortable with technology, Tracy recommends investing in a fitness watch, which can help you not only track your heart rate and daily step counts, but also set goals and track your progress over time. “You'll notice that not only can you exercise longer, but you can increase the intensity, and your heart rate will actually not be going as high as when you initially started exercising,” a sign that your heart is getting stronger.

If you have risk factors for heart disease, or have had a cardiac event in the past, it’s always a good idea to check in with your healthcare provider before you begin a new exercise routine, Tracy says.

Once you do begin moving more regularly, make sure to listen to your body. If you’re having symptoms like shortness of breath, chest pain, or chest pressure that's disproportionate to your level of physical exertion, back off. Take some time to rest. If you later go back to the same activity and experience similar symptoms, check in with your doctor, who can help you chart an appropriate path forward.

The bottom line is that movement is mandatory for a healthy lifestyle, but it doesn’t have to be extreme. “In order to be healthy, you don't have to do high intensity exercise. You start slow, you set yourself goals, you maintain it, you spice it up, and it becomes part of your daily regimen.”

If we incorporate regular movement into our lives — and it can be as simple as parking at the back of the lot and carrying a basket instead of pushing a cart at the market — we’re going to reap the benefits, Tracy says. Plus, “it’s never too late to start exercising,” no matter your age group.

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