General Home Activity and Exercise Guidelines

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1 General Home Activity and Exercise Guidelines After a Heart Attack / Angina Angioplasty / Stent Heart Failure Heart Health Risk Reduction Program Vancouver Island Health Authority Created January 2002; Revised June 2009 By the Cardiac Risk Reduction Program This handout was developed to give activity guidance to patients after a heart attack, angina, angioplasty, stent and / or heart failure and is meant to go with the information in the Heart and Stroke Foundation RECOVERY ROAD binder. Remember this handout gives general information, so please consult your doctor or health care team for specific activity guidance. Recognition and thanks is given to the New Brunswick Heart Center / Atlantic Health Sciences Corporation for permission to use their information in this handout.

2 TABLE OF CONTENTS Page Number INTRODUCTION... 2 TIPS FOR SAVING ENERGY... 3 ACTIVITY IMPORTANT POINTS TO REMEMBER... 3 EXERCISE PROGRAM FOR THE EARLY RECOVERY PERIOD... 5 WARM UP & COOL DOWN... 5 CARDIAC WALKING GUIDELINES... 8 SIGNS TO STOP AND REST... 9 STAIRS AND HILL CLIMBING... 9 GUIDELINES FOR ACTIVITY INTENSITY RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort) STRENGTH ACTIVITIES WAYS TO REDUCE STRESS SEXUAL ACTIVITY EXERCISE LOG for (Name) EXERCISE LOG INTRODUCTION When you first go home, you will be looking to find a balance between rest and activity. The time it takes to improve or return to a healthy activity level will vary greatly, depending on your age, energy level, current health condition and your previous state of health and fitness. These activity guidelines will support you to progress at a moderate pace that considers the needs of your healing heart. You should slowly increase your activity level during your hospital stay and carry on at home. For example, slowly progressing your pace will give a heart muscle time to heal. It will also help you be more physically active after angioplasty (balloon procedure) or if you have angina (chest discomfort) or heart failure (weakness of Page 2 of 14

3 the heart muscle which can cause fluid to collect and make you short of breath or tired). Remember being active helps reduce the risk of further heart disease and or a heart attack. After 6 weeks many people will be fully active and everyone should carry on with their regular exercise program. Note some people may have shortness of breath and chest discomfort due to the heart damage and may have to limit their activity. If this applies to you, regular exercise within these limits is still important. 1 For best health benefits you should exercise regularly all through your life. TIPS FOR SAVING ENERGY Remember, all on your feet activity is work for your heart. Times of REST and ACTIVITY should be well BALANCED and spaced out during the day. But, a day of house or garden work DOES NOT take the place of your cardiac walks. When you first go home plan your day so that you do not have to climb stairs you don t need to. Remember, after a heart attack getting dressed in the morning, eating regular balanced meals and your walking program are your top priorities. Allow lots of time to finish your task; pace yourself and DO NOT RUSH. Alternate heavy and light tasks during the day. Be sure to take enough time for rest during any activity you do. Do not try to do more in a day than your body says you can. Avoid long sleep periods during the day; short naps are okay. ACTIVITY IMPORTANT POINTS TO REMEMBER 2 1. EATING AND DRINKING Exercising just before a meal may affect your appetite. Wait 1-2 hours after a large meal before exercising. It is okay to walk slowly after a snack. Avoid coffee and alcohol before exercising. The caffeine in the coffee is a stimulant and may affect your exercise ability. Studies have shown that alcohol intake slows the flow of blood through the heart arteries. Be sure to stay hydrated. 2. WEATHER & OTHER FACTORS Hot, cold, and windy weather may raise your heart rate and make you tire more easily. Be sure to slow down your pace and dress for the weather. In cold weather, exercise in the warmest part of the day. On hot days exercise in the coolest part of the day. 1 Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation. 2 Parts were taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation. Page 3 of 14

4 In extreme weather conditions you may find it easier to walk in a mall or use a stationery bike. Avoid saunas, very hot or cold showers, jacuzzis and hot tubs in the early recovery period. Check with your doctor about use later on. 3. Try not to compete with anyone, including yourself, while exercising. 4. Strenuous activities using your arms can increase your blood pressure, check with your doctor about how much weight you can lift. In the early recovery period avoid lifting, pushing and pulling more than pounds, such as lifting groceries, small children, pets, vacuuming, etc. These and activities that keep your arms above shoulder level put extra stress on your heart; so take rest breaks often with any arm activities. (See Strength Activities page 11) 5. Heavy straining or breath holding (i.e. bowel movements) can put a great strain on your heart. Eat high fibre foods, use stool softeners, or laxatives if needed to prevent constipation. 6. Check with your doctor before starting or going back to high-energy sports / activities (such as tennis, squash and jogging) and sports such as swimming where you use a lot of upper body muscles. 7. Your exercise should be steady and even, slowing or stopping only to check your pulse. Warm-up and cool-down are very important parts. Always include them. 8. Think about getting a good pair of walking shoes having good foot support is important. Wear comfortable clothes. 9. Always take your Nitro with you, if it has been prescribed for you. 10. Check with you doctor as to when it is okay for you to drive again. REMEMBER, if you stop your regular exercise program, within 2 3 weeks the strength or capacity you gained will decrease close to the level you were at before you started the exercise program. Your heart, like any muscle, strengthens with exercise and you need to steadily increase your activity to keep progressing. If you are sick for a few days, go back in your exercise log to the day before you were sick; begin again from this point as you resume your exercise program. EXERCISE, LIKE YOUR MEDICATION, MUST BE TAKEN IN THE RIGHT AMOUNT; TOO MUCH OR TOO LITTLE IS NOT GOOD FOR YOU. Page 4 of 14

5 EXERCISE PROGRAM FOR THE EARLY RECOVERY PERIOD After a heart attack or heart procedure your body is in the process of healing or recovery. During this time, exercise helps to improve your general strength, endurance and prevents the effects of inactivity. Walking will be your main form of exercise during the early recovery period. Always start with a warm up and finish with a cool down as part of your exercise program. After your exercise program (and cool down), rest for 5-10 minutes. Feeling tired after activity is okay but not exhaustion. You should feel refreshed after resting and able to carry on with your normal activity. WARM UP & COOL DOWN 3 A warm up and cool down routine uses slow / easy walking and warm up exercises to gradually increase your heart rate. A warm up increases blood flow to supply working muscles. A warm up will reduce the risk of injury, increase range of motion, relaxes muscles and mentally prepares you for exercise. Use some of the exercises below in your warm-up. For your warm up do about 5 minutes of slow walking and then ease into your cardiac walk. A cool down slowly brings your heart rate and breathing back to normal. It helps prevent pooling of blood in legs, which can lead to a lightheaded feeling. It helps relax muscles and prevent stiffness after physical activity. Cool down at the end of your walk with another 5 minutes of slow walking to allow your heart rate to slow down and blood pressure to lower. Note: If you have heart failure, the warm up and cool down walk / routine should slowly be increased to more than 10 minutes each. Instructions for Warm Up Exercises: 1. Once or twice a day try doing each exercise 3 10 times. 2. Some exercise will be done sitting and some standing. When sitting, sit tall on a firm chair with your feet flat on the floor. 3. The exercises should be done slowly. Do not force any movements. Breathe normally. NEVER HOLD YOUR BREATH! 4. Remember, good posture is important. Try to keep your shoulders back and relaxed. Avoid slumping forward. Note: the exercises below are warm-up exercises not stretches. If you plan to include stretches in your routine, they should be done after your cardiac walk. 3 Parts of this section were taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation. Page 5 of 14

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8 Page 8 of 14 CARDIAC WALKING GUIDELINES 1) A CARDIAC WALK is a walk solely intended for the benefit of your heart and blood flow. The cardiac walk is the conditioning phase of an exercise program. It comes after the warm up and before a cool down. At first, walk (at your pace) with a partner to help your confidence. Plan a route where you can bench-hop if needed, then work up to a non-stop walk. Please look at the GUIDELINES FOR ACTIVITY INTENSITY (Page 11) to find out your pace and degree of exertion. 2) You started your Cardiac Walking Program in hospital. When you get home continue with this. Begin by walking the same number of minutes as you were doing in the hospital. Do 3 walks per day, preferably outdoors or in a mall. 3) As long as you are not experiencing difficulty, increase the time of your walks by up to 1-2 minutes each day based on your morning fatigue level and your Exercise Effort Scale (refer to GUIDELINES FOR ACTIVITY INTENSITY Page 11). Note: if you have had a heart attack or have heart failure go a little slower in increasing your walking time for the first 4 weeks. Slowly increase the distance and pace of your walks as long as you are not experiencing difficulty. Keep track of your progress in your exercise log. A sample record is included in this package (pages 15-17). 4) If you have increased your cardiac walk to a total 20 minutes, you can reduce the frequency to twice a day and slowly increase the time of each walk to 30 minutes. Some people may not be able to go walk to 20 minutes. Continue to walk the length of time that is comfortable for you. 5) If you have increased your cardiac walk to 30 minutes, you can reduce the frequency to once a day and slowly increase the time up to 60 minutes. The goal is to eventually do walk minutes most days of the week. Please note we suggest you walk daily versus every 2 nd day as suggested in HSF Recovery Road on page 65 Note - A stationary exercise bike or treadmill can be used in place of walking when the weather is poor or just for a change of pace. Start slowly with 5 minutes. Slowly progress your walking program. Do not use any resistance until you can easily cycle for at least 10 minutes. Do not increase the grade on the treadmill until you can walk on a flat level for 20 minutes. The use of a treadmill takes more balance and coordination than regular walking. Be sure to hold the handrails and have someone with you for safety. 6) If you attend a community exercise cardiac rehab program you will receive further guidelines about exercise, stretches, etc. CARDIAC EXERCISE HELPS: Your heart work better Increase physical & mental stamina To improve blood flow to the heart Lower blood pressure Promote good sleep patterns Oxygen delivery to the tissues Increase stress tolerance Increase energy levels Improve muscle relaxation Reduce blood sugar levels Balance food eaten & energy used Increase good cholesterol (HDL)

9 SIGNS TO STOP AND REST Please look at the GUIDELINES FOR ACTIVITY INTENSITY (Page 10) to find out your pace and degree of exertion. If you notice it is harder than usual to do your exercise program (i.e., your Exercise Effort is higher than you expect for a certain amount of exercise, compared with previous sessions), then slow down or STOP if necessary. Think about some possible reasons for this change: a change in weather conditions, a recent heavy meal or a busy day. Signals to slow down or stop: if you have exceeded recommended target heart rate or RPE shortness of breath or difficulty breathing discomfort in chest,, arm, back, jaw or unusual joint or muscle pain irregular heart beat, dizziness, nausea If these symptoms settle after 5 minutes of rest, rest for a further 5-10 minutes and then carry on exercising at a slower pace. If symptoms are not relieved tell your doctor. Stop your activity if you notice: sudden pain, heaviness, tightness or pressure in the chest, neck, jaw, arms back, etc extreme shortness of breath sudden excessive sweating nausea feeling cold and clammy head pounding feeling of weakness unusual fear or worry If you have angina symptoms, stop, sit & rest for 2-5 minutes. If the symptoms do not go away take nitroglycerine (if prescribed) as directed (1 spray or tablet every five minutes to a total of 3 nitro tablets or sprays in 15 minutes). IF SYMPTOMS HAVE NOT SETTLED WITHIN MINUTES, CALL 911 (Don t drive yourself). STAIRS AND HILL CLIMBING It takes more energy to climb stairs or hills than to walk on the level take your time and rest when you need to. You should have the breath to talk when going uphill. Slow down and rest if it is hard to talk. Gradually add hilly challenges into your program as your strength and endurance improve. Page 9 of 14

10 GUIDELINES FOR ACTIVITY INTENSITY After you leave the hospital it is up to you to slowly increase your activity level. Two ways to try to measure how strenuous your exercise is: Rate of Perceived Exertion (perceived effort) and Heart Rate. If you have heart failure or take Beta Blocker medication you should use the Rate of Perceived Exertion (RPE) scale and not your Heart Rate to monitor your exercise exertion. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort) How to use the scale: During exercise we want you to be aware of how much effort you are using and rate it on the scale below. This rating should show your total effort; it includes the strain and fatigue in your muscles, shortness of breath and physical effort. You should pay attention to your overall feeling and not just one factor, such as leg pain, feeling short of breath or exercise force. Exercise Effort Required The Way You Feel 0 Nothing at all Resting Exercise Phase 1 Very Easy 2 Easy 3 Moderate 4 Somewhat Hard Enough breath to sing/whistle. Activity easily done. Slow walk to comfortable walk. Enough breath to talk. Will feel warmer; feel muscle effort. Breathing slightly faster. 5 Hard Brisk to fast walk. Warm up for 5-10 min & Cool down for 5-10 min Start walking in this range for the initial weeks of your cardiac recovery 6 7 Very Hard 8 Vigorous exercise. Difficulty talking, breathing hard. Feeling tired. For some people your exercise may progress into this level. Slow down, you have gone over the recommended level of activity! 9 Very, Very Hard Heavy breathing. Very short of breath. Unable to maintain. 10 Maximal Effort All out. Exhausted. *Based on the Borg Scale for Rating Perceived Exertion (1985). Page 10 of 14

11 STRENGTH ACTIVITIES 4 Light to moderate level strength training activity is safe if you have heart disease but CHECK WITH YOUR DOCTOR BEFORE STARTING ANY STRENGTH TRAINING. Strength training makes you work your muscles against resistance. Adding strength training makes it easier to carry out the regular activities of daily living such as yard work, lifting and carrying groceries. Strength training along with endurance activities on a regular basis can also help you manage your weight, improve your metabolic rate (which can affect how fast you lose weight. Normally strength activities are not recommended for the first 3-5 weeks after a heart attack and 2 weeks after an angioplasty (without a heart attack). Strength activities are not recommended until heart failure is under control; so check with your doctor. If you plan to do strength activities we suggest you get specific guidelines from staff at one of the Cardiac Rehabilitation programs. WAYS TO REDUCE STRESS 5 Learning to live with a heart attack, angina, heart failure or any heart condition can be stressful. Your emotions affect your breathing and your heart. It is important and helpful to find a way to relaxing. (also see page in HSF Recovery Road) 1. LEARN RELAXATION TECHNIQUES 2. IDENTIFY YOUR STRESSORS AND YOUR REACTION TO STRESS Learn what stressful situations make your body over react. You can learn to control your body s response to stress and feel less tired and fearful. Reduce time pressure by deciding which activities you enjoy and which you must do, then weed out things that don t fit into one of these two areas. Look at your must do list and see what you may be able to ask someone else to do. Slow down. Pace, don t race. Allow lots of time to get things done. Take mini breaks. 3. EXERCISE - See guidelines in this package 4. CHANGE YOUR PERSPECTIVE Practice Acceptance a. Instead of worrying about what will happen if try saying to yourself will what is happening now matter next week? Tomorrow? If it will make a big difference, then it deserves a cool, calm approach. b. Watch out for trying to do things perfectly set realistic goals. If someone else does the job differently than you would have Is your way really the only way? Take a shortcut once in a while not everything, all the time has to be A-1. Use your energy for activities you enjoy. 5. FIND HUMOUR IN IT Try to find some humour in the situation. If everything were perfect, life would be quite boring. So laugh at yourself. Loosen up and enjoy life. Unwind by taking a stroll, watching a sunset, talking with a friend, or listening to music. 4 Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation. 5 Taken with permission from the CHR Respiratory Rehabilitation Page 11 of 14

12 6. HAVE REALISTIC EXPECTATIONS Set up a realistic plan of activities, including time for fun. All of us need to change our expectations of ourselves from time to time. This is more true as we age and if illness limits our activities. Learn what your sources of stress are and change the ones you can. Learn ways to control negative emotions. For example: take time out or use self-talk. Seek help to deal with anger or problems instead of letting them build up. Friends can be good medicine. Conversation, regular social outings, and sharing thoughts can reduce stress. SEXUAL ACTIVITY Another activity that needs to be talked about is sex. Please talk to your doctor or program staff about any concerns or questions you or your partner may have about sexual activity after a heart attack, angioplasty or heart failure. Please refer to page 90 in HSF Recovery Road for additional information on sexual activity. Page 12 of 14

13 EXERCISE LOG for (Name) Date Type of activity (i.e. walk) Walk 1 Time exercised (In minutes) Heart Rate Before Exercise (Optional) Rate of Perceived Exertion (or Heart Rate) During Rate of Perceived or Heart Rate After Exercise How do I feel? Conditions e.g. weather? Walk 2 Walk 3 Heart rate or pulse rate refer to the HSF Recovery Road page 66 Rate of perceived Exertion - refer to the Guidelines for Activity Intensity page 10 Page 13 of 14

14 EXERCISE LOG Date Type of activity (i.e. walk) Time exercised (In minutes) Heart Rate Before Exercise (optional) Rate of Perceived Exertion (or Heart Rate) During Rate of Perceived or Heart Rate After Exercise How do I feel? Conditions e.g. weather? Heart rate or pulse rate refer to the HSF Recovery Road page 66 Rate of perceived Exertion - refer to the Guidelines for Activity Intensity page 10 Page 14 of 14

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