Exercise and Activity After a Heart Attack After a heart attack, the damaged heart muscle needs time to heal. This involves allowing scar tissue to form. The scar from a heart attack needs about 6 weeks to become strong enough to handle moderate to heavy work. During this time, be sure to avoid any excess physical and emotional stress. Why Exercise? To decrease the heart s need for oxygen. The heart can work more efficiently. The heart pumps fewer times while still meeting the body s need for oxygen-rich blood. To reduce your triglyceride and LDL (bad cholesterol) levels. To increase your HDL (good cholesterol) levels. To lower blood pressure. To help the body create tiny new blood vessels which bypass clogged or diseased blood vessels. To allow blood vessels to expand (dilate) during times when more blood flow is needed. To keep the vessels clear of blood clots and plaque build-up. To reduce insulin resistance and blood sugar levels in persons with diabetes. To help manage weight. To reduce stress and improve your emotional well-being. To reduce risk of osteoporosis as well as colon and breast cancer. What Kind of Exercise is Beneficial? Aerobic exercise will help you return to an active lifestyle. This involves constant movement of the major large muscle groups, such as your legs and arms. For instance, walking or using a stationery bike allows your body to use oxygen more efficiently.
Resistance training helps strengthen major muscle groups and helps burn more calories. Your Hospital Exercise Program While in the hospital, you will work with the Cardiac Rehab staff to find a program that is right for you. The staff will check your heart rate and blood pressure while you walk. This helps them to know how your body is responding to exercise. It also helps them to suggest a home program that is best for you. Your Home Exercise Program When first home, you will want to follow these guidelines. Start your home exercise program the day after you go home from the hospital What activity How often How long How hard Walking on a level surface or using a stationary bike, or treadmill. Most days of the week (5-6 days) Start with minutes of exercise times a day. Increase your walking or biking 1-2 minutes each day. Your goal is to reach 30-45 minutes of continuous training. Use the rating of perceived exertion (RPE) scale or Talk Test to gauge how hard you are working. This will be explained later in this handout. How Should I Increase My Exercise Program? Example: Begin with 5 minutes of walking 3-4 times per day. Add 1-2 minutes to each session each day. As you add time, the number of sessions can be decreased. For instance, when you complete 10 minutes of exercise, decrease your routine to 3 sessions per day. When you complete 30 minutes, decrease the frequency to 1 session per day. 2
Intensity: Once you are able to perform 20-30 minutes at one time, intensity can be increased slowly. Increase your intensity for 3-5 minutes at a time. Then resume your normal routine for the rest of your workout. Increase the intensity slowly. Always keep the RPE scale and Talk Test rule in mind. (see p. 4). How Your Body Responds to Exercise As a rule, you may notice you are breathing faster and your heart rate increases when you exercise. You can also expect to sweat and to have some muscle fatigue. It s also important to know what is NOT normal. If you notice any of these symptoms, STOP exercising and call your local doctor: Severe heart pain (angina) Excessive shortness of breath or unable to talk Excessive sweating Blurred vision Frequent skipped beats Dizziness, light-headedness Nausea Unexplained fatigue Cramping in your arms and legs If you cannot reach your doctor, call the UWHC paging operator at (608) 262-0486 and ask to speak with the cardiac resident on call. Give the operator your name and phone number with the area code. The doctor will call you back. If you live out of the area, please call: 1-800-323-8942. If you feel this is an emergency, call 911 right away. Do not drive yourself to the hospital. 3
Knowing How Long and Hard to Exercise Your heart rate and how you feel will guide how long and hard you should exercise and what activities you should do. Here are three easy ways to check your response. Certain medicines, such as beta blockers, make it hard to increase your heart rate to the prescribed level. Therefore, the Talk Test and RPE scale are better ways to measure exercise intensity. The Talk Test Choose a level of exertion that allows you to still talk while you exercise. You should be able to talk in short sentences, but will likely not be able to sing. Your Heart Rate Place your arm so that your palm is face up. Take the second and third fingers of your other hand and place them over the blood vessel as shown below. (Do not use your thumb.) Gently feel for the pulse. Count your heart rate for 15 seconds. Multiply that number times 4. x 4 = beats per minute Take your heart rate for a few days in a row so that you know what is normal for you. If your heart rate is below 50 or above 120 beats per minute while at rest, call your doctor. Your heart rate DURING EXERCISE should not be 30 beats per minute more than it was at rest. 4
Your RPE (Rating of Perceived Exertion) RPE is a measure of how hard you feel you are working. It is based on your muscle use, breathing, and overall feelings of effort. In most cases, you should aim for somewhat hard (11 to 14 on the scale) during exercise. If what you are doing gets harder than that, you need to either slow down or take a rest. Perceived Exertion Scale 6 7 very, very light 8 9 very light 10 11 fairly light 12 13 somewhat hard 14 15 hard 16 17 very hard 18 19 very, very hard 20 What to Wear for Exercise Dress in loose-fitting, comfortable clothing. In warmer weather, a cotton T-shirt and shorts may be enough. In cooler weather, layer your clothing if you plan to exercise outdoors. For instance, a windbreaker over a long sleeve shirt may work well. Covering your nose and mouth with a scarf can also help to warm the air you breathe. Avoid heavy, bulky coats or jackets. They can increase the work it takes to move your body. Your body heat naturally increases as you exercise. You don t want to become overheated by dressing too warmly. Wear jogging or walking shoes. Shoes with supportive arches reduce foot and knee soreness that can occur when you exercise for longer times. If you have diabetes, be sure your shoes have a large enough toe box and the heels do not pinch or cause blisters. 5
Importance of a Warm-up and Cool-down Warm-up- The first 3-5 minutes should be an easy pace of walking or biking with no resistance. This will increase your blood flow and warm up your muscles for activity. Cool down At the end of your session, slow down to an easy pace for 3-5 minutes. This prevents sudden changes in blood pressure that can occur if you stop too quickly. Stair Climbing Climbing stairs can be strenuous activity. While healing, you may need to climb stairs at a slower rate. At first, be sure to pace yourself to one stair every 2 seconds. As you heal, you can slowly increase your rate. Step up and down with the leg on your dominant side. If you are right handed, this would be your right leg. As you heal, increase the rate at which you climb stairs. Activities You Can Expect to Do If you have had a cardiac catheterization or stent placed in an artery of your heart, avoid lifting more than 10 pounds for 7 days. The First 6 Weeks after a Heart Attack Light housework (dishes, dusting, cooking) Home crafts and light carpentry Driving for short distances, riding the lawn mower Dining out, shopping for short times Light auto work, appliance repairs Level walking or outdoor biking at a relaxed speed Talk to Your Doctor before Adding These Activities Heavy arm work or lifting over 30 pounds (young children, armloads of wood, water softener bags, garage doors, snow shoveling) Heavy hammering 6
Sexual Activity Once home, you may engage in sexual activity as you feel able and have the desire. The peak effort with sex is equal to climbing stairs at a moderate pace. That would likely be somewhat hard on the exertion scale. During sex, the heart rate may peak at 120 beats per minute and remains at that rate for only a short time. Some heart medicines can affect your sexual drive and ability. If you have questions or concerns about this, please talk with your doctor or heart care team. Being Careful of Weather Extremes Hot weather - Heat and humidity can cause strain on your heart and blood flow. Avoid exercising in direct sun or when it is over 85 F unless the humidity is low, there is a breeze, or there is shade. Early mornings and evenings are best. Exercise outdoors only if the heat index is less than 85 F. Heat Index Table HEAT INDEX 130 or above 105 to 130 90 to 105 affects on the human body heat stroke highly likely with continued exposure heat stroke likely with prolonged exposure heat stroke possible with prolonged exposure 7
RELATIVE HUMIDITY AIR TEMPERATURE (F) 70 75 80 85 90 95 100 105 110 115 120 30 67 73 78 84 90 96 104 113 123 135 148 35 67 73 79 85 91 98 107 118 130 143 40 68 74 79 86 93 101 110 123 137 151 45 68 74 80 87 95 104 115 129 143 50 69 75 81 88 96 107 120 135 150 55 69 75 81 89 98 110 126 142 60 70 76 82 90 100 114 132 149 65 70 76 83 91 102 119 138 70 70 77 85 93 106 124 144 75 70 77 86 95 109 130 80 71 78 86 97 113 136 85 71 78 87 99 117 90 71 79 88 102 122 95 71 79 89 105 100 72 80 91 108 http://www.erh.noaa.gov/er/iln/tables/htm 8
Cold weather avoid exercising outdoors when the temperature or wind chill factor is below 0 F. The body and heart have to work harder to walk against wind and snow. Learn to pace yourself and avoid sudden bursts of effort. You may need to work and rest at intervals to maintain this rating. Your exercise should never feel harder than somewhat hard. Shoveling After 3 months, you may be able to shovel light snow again. Before doing so, warm up and do gentle stretches. Pace yourself. You may safely shovel if your effort is controlled at the somewhat hard level. Again, mix work and rest every 2-3 minutes to avoid overdoing it. While shoveling, remember to Avoid holding your breath. Shovel fresh snow rather than wet, packed snow. Push instead of lifting. It s easier on the back and spine. Push shovels are sold for this purpose. Avoid picking up too much snow at once. Use a smaller shovel or only fill it ¼ to ½ full. Bend your legs and not your back. Keep the small of your back straight. This avoids placing extra stress on your spine. Your Cardiac Rehabilitation Program Cardiac Rehabilitation is a medically supervised program that features exercise and education for people recovering from a heart attack, bypass surgery, coronary angioplasty or stent, heart transplant, or valve surgery. The program is designed to help strengthen your heart and other muscles, as well as guide you to a heart healthy lifestyle. You can receive this follow-up care through the UWHC Cardiac Rehab program or through a program nearer your home. Your local Cardiac Rehab program: Phone number: UWHC Cardiac Rehab (608) 263-6630 Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright 2/2014 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6090 9