A Answers (4)
Sameer A. Sayeed, MD, Cardiology, answeredIt is safe to exercise after a heart attack, provided a few criteria are met. After the heart attack, the patient should have an angiogram to identify their coronary artery anatomy and to determine if there is a severe plaque or blockage that is responsible for the heart attack. If a severe blockage is found, it should be fixed with angioplasty and stenting, or in the case of triple vessel coronary disease, a coronary artery bypass should be peformed before one is allowed to exercise. After revascularization, a stress test should be performed to make sure there are no other symptomatic blockages and that the heart is receiving adequate blood flow. This should also be done before allowing exercise. The patient should also have an echocardiogram to evaluate the structure and function and strength of the heart prior to allowing exercise. After a heart attack, the patient and their heart should be allowed to rest for at least 2 weeks prior to allowing safe exercise even if it was a small heart attack. The patient should also be monitored for a short period after the heart attack to make sure they are not having any heart rhythm abnormalities prior to allowing safe exercise.
Anthony Komaroff, MD, Internal Medicine, answeredYour first exercise after a heart attack or procedure should take place in the setting of a cardiac rehabilitation program during the first few weeks of your recovery. Your heart rate will be monitored to make sure you don't develop any dangerous heart rhythms. If you don't attend rehabilitation, you should have a pre-exercise stress test, which can help set the guidelines for your exercise prescription.
What kind of exercise is best, and how much should you do? Aim for 30 minutes or more of moderate activity per day as a good initial goal (and if you want to build up from there, all the better). Aerobic exercise, which employs large muscle groups in a rhythmic, repetitive fashion for prolonged periods of time, has long been considered the best type of exercise for the heart. But flexibility exercises (those that stretch muscles) and resistance exercises (which strengthen them) are also good. What follows is a quick guide to exercise for cardiac rehabilitation.
- Get started. If you aren't doing much physically, then mild exercise a few times a week will cut your heart disease risk in half. Even mild activity, like walking at a reasonable pace, can make a big difference in the health of your blood vessels. Raising your heart rate and dilating arteries modestly can help to lower your blood pressure and prevent atherosclerosis. Start with 20- to 30-minute walks three days a week, then build up to 30 minutes or more nearly every day. Or try three 10-minute walks every day, which is just as effective. If you feel chest pressure, lightheadedness, or marked shortness of breath, see your doctor right away.
- Keep going. Daily exercise will help you to burn more calories, and that will have a whole range of beneficial health effects.
- Pump up the volume. If you can do mild or moderate physical activity daily, start doing short bursts of more intense activity. You can walk five miles every day at the same slow clip, and you will burn plenty of calories. But short bursts of intense activity -- 30 to 60 seconds of really pushing yourself -- can help take the health of your blood vessels to a new level. If you walk for exercise, for instance, increase your pace, try a slow jog, or try walking in a pool (the water provides resistance, making you work harder). This type of moderate physical stress on the arteries helps keep them younger.
Exercise will be central to your recovery after diagnosis and treatment for heart disease, whether you have had a heart attack, angioplasty or stent placement, coronary artery bypass surgery, valve replacement, heart transplant or diagnosis of angina or heart failure. You can work with your doctor and a cardiac rehabilitation team to determine the type and level of exercise that is best for you.Benefits from exercise for heart disease patients are greatest when a person exercises 3 to 6 times per week. Many patients jump-start their new healthy lifestyle with participation in a cardiac rehabilitation program. Studies have shown that people who attend cardiac rehabilitation programs are more likely to be alive and well at 5 years, compared to those who do not. If you participate in a program, you will likely attend two or three exercise sessions per week at the cardiac rehabilitation center and supplement this with exercise at home, such as walking. Sessions generally last around an hour and may also include education about nutrition, stress reduction, medications, smoking cessation, and exercise. After supervised, monitored exercise for 24 to 36 sessions, participants are encouraged to continue with regular exercise, either at home, in their community, or in ongoing programs at the rehabilitation center.
It all depends on the time frame from when you sustained a heart attack. It is important to get your cardiologist’s or other physician’s approval for you to start any exercise program. When you have a heart attack, your heart may not function as well as before the heart attack. Your heart may be weakened, so it will take time to build it up to exercise at the same level you exercised before.
You need to have a physical before you begin a program and follow the physician’s recommendations for safe progression. If you begin to experience any chest pain, stop immediately. For good heart health it is recommended that everyone exercise at least 30 minutes a day, most days of the week. The 30 minutes can be broken down into 10 or 15 minutes segments if 30 minutes is currently too difficult for you.
(This answer provided for NATA by the King College Athletic Training Education Program.)