HEART FAILURE AND EXERCISE

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1 JOHN MUIR HEALTH Why Exercise? How Often Should I Exercise? What Should My Home Exercise Program Include? Home Exercise Daily Log Taking Your Pulse Rate of Perceived Exertion Scale Exercise Session Review Cardiac Conditioning and Pulmonary Rehabilitation INTRODUCTION Exercise is an important factor in managing heart failure and improving cardiovascular fitness. Your doctor will advise you when it is safe to start an exercise program. WHY EXERCISE? Regular exercise has many benefits. Aerobic, or cardiovascular exercise, can: Strengthen your heart and cardiovascular system Reduce your heart disease risk factors, such as high blood pressure and being overweight Improve your circulation and help your body use oxygen better Build energy levels so that you can do more activities without becoming tired or short of breath Improve balance and joint flexibility Help reduce stress, tension, anxiety and depression H OW OFTEN SHOULD I EXERCISE? To achieve maximum benefit, your eventual goal is to exercise three to four times a week, for minutes per session. Every other day is a good rule of thumb.

2 Page 32 WHAT SHOULD MY EXERCISE PROGRAM INCLUDE? Every exercise session should include a warm-up, a conditioning phase and a cool-down. 1. The warm-up helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles by slowly increasing your breathing, circulation (heart rate) and body temperature. It can also improve flexibility and reduce muscle soreness. The best warm-up includes stretching, range of motion activities and beginning the activity at a low intensity level. STRETCHES FOR THE MAJOR MUSCLE GROUPS Hold each stretch for 15 seconds for warm-ups and 30 seconds for cool-downs. Do NOT bounce or jerk. Stretch slowly. Do NOT stretch through pain. Leg stretches can be done on the floor or on the bed. Shoulder and Upper Back Stretch Reach overhead and slightly back with both arms. Keep your shoulders and neck aligned and your elbows behind your shoulders. With your palms facing the ceiling, turn your fingers inward. Take a deep breath. Breathe out and lower your elbows toward your buttocks. Hold for 5 seconds, then return to starting position. Repeat 3 times.

3 Page 33 Shoulder Clock Imagine that your right shoulder is the center of a clock. With your shoulder slowly trace the outer edge of the clock. Move clockwise first, then counterclockwise. Repeat 3 times. Switch shoulders. Side Stretch Shoulder Girdle Stretch Place one hand on the outside elbow of the other arm. Pull the arm across your body. Hold for 20 seconds. Switch sides. Stretch your right arm overhead. Slowly bend to the left. Don t twist your torso. Hold for 20 seconds. Return to starting position. Repeat 2 times. Switch to the other side. Shoulder Squeeze Raise your arms to shoulder height, elbows bent and palms forward. Move your arms back, squeezing your shoulder blades together. Hold for 5 seconds. Return to starting position. Shoulder Shrug Raise both of your shoulders as high as you can, as if you were trying to touch them to your ears. Keep your head and neck still and relaxed. Hold for a count of 5. Release. Repeat 5 times. Neck Flex Rest the back of your left hand against your lower back. Place your right palm on the top of your head. Gently pull your head forward and down until you feel a stretch in the neck muscles. Don t force the motion. Hold for 20 seconds, then return to starting position. Switch arms.

4 Page 34 Seated Rotation Fold your arms, elbows just below shoulder height. Turn from the waist with hips forward. Turn your head last. Hold for a count of 5. Return to starting position. Repeat 5 times. Switch sides. Hamstring Stretch Single/Double Leg Pull Pull one knee to your chest. Hold for 20 seconds. Then release. Repeat 2 times. Switch legs. For a double leg pull, pull both legs to your chest at the same time. Repeat 2 times. Put a towel behind one knee or calf. Use the towel to pull the leg toward your chest, keeping the leg straight or slightly bent. Hold for 20 seconds. Then lower the leg. Repeat 2 times. Switch legs. Hip Rotator Stretch Rest your right ankle on your left knee. Place a towel behind your left thigh and use it to pull the knee toward your chest. Feel the stretch in your buttocks. Hold for 20 seconds. Release. Repeat 2 times. Switch legs. Lower Back Rotation Drop both knees to one side and turn your head the other direction. Keep your shoulders flat on the floor. Hold for 20 seconds. Switch sides. Repeat 2 times.

5 Page Aerobic exercise produces the most benefits for your heart. These exercises include activities like walking, cycling, rowing, low-impact aerobics or water exercise.

6 Page 36 QUICK TIPS Wait at least 1 1/2 hours after eating a meal before exercising. Dress in comfortable clothing and wear supportive footwear. When drinking liquids during exercise, remember to follow your fluid restriction guidelines. Start slowly, then begin to gradually increase your exercise intensity. Check your pulse rate before, during and after each exercise session. Your pulse rate should not exceed beats above your resting pulse rate. Remember, some medications may slow your heart rate. (See pulse counting illustration, page 36) Make a daily log of your activity and responses to the exercise. (See exercise log, page 35) Bring this record with you when you visit your physician. With your doctor s approval, use the guide below to help start a home exercise program. If you are new to exercise, begin by exercising in 3-5 minute bouts, four times a day as indicated on the chart below. Week of Exercise Frequency (times/day) Time (duration in minutes) 1st 4 3 to 5 minutes 2nd 4 5 to 7 minutes 3rd 3 7 to 10 minutes 4th 3 10 to 12 minutes 5th 2 12 to 15 minutes 6th 2 15 to 17 minutes 7th 1 17 to 20 minutes 8th 1 20 to 30 minutes

7 Page 37 DAILY LOG OF MY HOME EXERCISE PROGRAM Date Resting Pulse Exercise Pulse Time Perceived Exertion Comments

8 Page 38 TAKING YOUR PULSE 1. Place the tips of your index and middle fingers on the palm side of your other wrist, below the base of the thumb. Or, place the tips of your index and middle fingers across the crease between your upper and lower arms. 2. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing. 3. Look at a watch or clock with a second hand. 4. Count the beats you feel for 10 seconds. Multiply this number by 6 to get your heart rate (pulse) per minute. Your pulse: x 6 = (beats in 10 seconds) (your pulse for 1 minute)

9 Page 39 RATE OF PERCEIVED EXERTION SCALE If you are unable to monitor your pulse, use the Rate of Perceived Exertion Scale (RPE). Stay in the green zone (numbers 11-13). You should be able to talk while you are exercising. No huffing and puffing. Stay with a comfortable push. Have fun! Choose an activity that you enjoy. 6 7 Very, very light exertion 8 9 Very light exertion Moderate exertion Somewhat hard exertion Hard exertion Very hard exertion Very, very hard exertion STOP EXERCISING AND CALL YOUR DOCTOR IF YOU: Have chest pain or feel dizzy or lightheaded Feel burning, tightness, pressure or heaviness in your chest, neck, shoulders, back or arms Have unusual shortness of breath Have unusual increased joint or muscle pain

10 Page The cool-down phase allows your body to recover from the conditioning phase. In order to cool-down, slowly decrease the intensity of your activity. This will allow your heart rate and blood pressure to return to near resting values. Do NOT sit, stand still or lie down right after exercise. This may cause you to feel dizzy, lightheaded or to have heart palpitations (fluttering in your chest). Use some of the same stretches in your cool-down that you used for warm-up. Take one last pulse count and pat yourself on the back! EXERCISE SESSION REVIEW Every exercise session should include a warm-up, a conditioning phase and a cool-down. Start with a Warm-Up Start with a 5 to 10 minute warm-up that includes both stretching and your chosen exercise. Warming up raises your heart rate slowly and loosens your muscles. Exercise at a slow pace for 5 minutes and stretch for 5 minutes. Get Your Heart Going Moderate intensity exercise does the most good for your heart. Exercise at a brisk pace. At first, 10 minutes may be all you can do. In time, you should be able to exercise at least 30 minutes a day. After this part of your routine, be sure to cooldown. Cool-down and Stretch Cooling down lowers your heart rate and blood pressure slowly. This helps keep you from getting lightheaded. Cooling down also helps you recover from exercise. Do your chosen exercise at a very slow pace for 5 minutes. Then stretch for 5 minutes.

11 Page 41 CARDIAC CONDITIONING AND PULMONARY REHABILITATION If you are interested in getting additional assistance with your exercise program, ask your physician to recommend Cardiac Conditioning or Pulmonary Rehabilitation. The Cardiac Conditioning and Pulmonary Rehabilitation exercise programs provide a protected environment and medical supervision to: Increase your physical strength and cardiovascular fitness Help you perform daily living activities Reduce your need for future hospitalization Reduce your anxiety about heart failure Give you a peer support group Give you more self-confidence Reduce risk factors Rehabilitation nurses and exercise specialists set achievable goals and tailor a series of exercises to each patient s abilities. The exercise sessions require a doctor s referral. Not all insurances will pay for this program but self-pay rates are available. For more information call: John Muir Cardiac Conditioning: Brentwood Campus (925) Concord Campus (925) Walnut Creek Campus (925) John Muir Pulmonary Rehabilitation: Concord Campus (925)

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