Recovery and Exercise After a Heart Attack

Accredited Exercise Physiologist, Janelle Oliver-Droomer, gives a great guide for recovery and returning to exercise post experiencing a heart attack.

One of the most important things you can do following a heart attack is to gradually start with some light exercise. Following an initial recovery period as instructed by your physician, exercise can aid recovery.

Research has proven that exercise is good for you and rarely harmful. People with Coronary Artery Disease who undertake exercise training, can reduce cardiac morbidity by 22%. It also reduces the risk of experiencing a secondary event with in the first 12 months. Less than 5% of heart attacks are triggered by physical exertion. (3)

Benefits of exercise occur within the heart itself and over your whole body.

Effect of exercise on heart disease:

can prevent further development of cardiovascular disease
helps prevents blood vessels narrowing further & blood clotting
increases you body’s ability to deliver blood to the heart, muscles and other organs
has proven to reduce some cardiac risk factors
these changes reduce the load on the heart at rest and during exercise, which improves cardiac output/efficiency of the heart

Direct effect of exercise on your whole body:

can help lower blood pressure
improves muscular strength
increases bone density
improves energy and exercise capacity
strengthens immune system
decreases the risk of heart disease
helps control/reduce body weight
improves mood/mental health
improve quality of life

The time and the level at which you start exercise will depend on many individual factors including your exercise history, how long ago your heart attack occurred, the extent of damage to your heart, the severity of heart disease and other co-morbidities.

This article covers 2 distinct groups:

Recovery phase – this can range anywhere from weeks to months post hospital discharge, depending on individual recovery

Ongoing secondary prevention – following on from your initial recovery phase and Cardiac Rehabilitation programs.

Recovery Phase

When you were in hospital, you most likely started your rehabilitation with walks up the corridors of the hospital. You may have also been referred to a Cardiac Rehabilitation program run by your local hospital or community health centre.

If not, contact your local medical practitioner and discuss the options for a referral to a formal Cardiac Rehabilitation program locally.

Many studies have found evidence that participation in Cardiac Rehabilitation reduces mortality and hospital re-admissions and improves quality of life. If you feel Cardiac Rehabilitation group isn’t for you, having an initial assessment with your cardiac team to discuss your plan would be beneficial. They may offer a home exercise program, online or remote assistance. This way you have some direction to exercise safely at an early stage and an avenue to ask questions if they arise, as you recover.

There are a few basic recommendations to follow to ensure your safety in commencement of an exercise program.

Consult with your physician prior to initiating an exercise program
Always warm up and cool down (light walk or movement 5min each)
Avoid exercise after a big meal (wait an hour or so)
Avoid exercise if you feel unwell or in extreme weather temperatures
Carry a phone with you and personal prescribed medications like Anginine or Ventolin
Monitor your blood sugar levels pre and post exercise if you are Diabetic

Duration – Start with light aerobic exercise like walking (refer to Figure 1 below) for a short period of time gradually increase duration first, and then intensity as tolerable.

Intensity – This is the key! Start at a light intensity, you will know it’s the correct intensity if you feel comfortable the whole time during the exercise, you can still have a conversation, you recover well immediately after and also continue to feel good the following day. Initially take on a little less than you think you can to avoid over doing it.

BORG RPE scale: A good tool to use is the BORG RPE scale (Rating of your perceived exertion).

This means that you rate how heavy or strenuous the exercise feels to you, using muscular strain and breathlessness as your guide. It is recommended starting exercise intensity around PRE 11-12 intensity, gradually progressing to 11-14 RPE as you get fitter and stronger and your exercise tolerance improves (refer to Figure 2 below)

Muscle strengthening – If you can tolerate walking on most days of the week for a few weeks, then you could commence some light resistance/strengthening exercises of your main muscle groups, which can complement aerobic training following a heart attack.

At this time in your recovery, it’s best done under the direction of your Cardiac Rehabilitation staff or an Accredited Exercise Physiologist.

Benefits from strengthening exercises;

improve muscle strength and endurance
slows ‘wear and tear’ on joints and reduce joint pain
reduce fatigue
reduce the risk of falls and injury
maintain good levels of bone mineral density
improve balance and help maintain an active independent lifestyle
overall better quality of life

Stretching – Incorporate some light stretches into your day. Cardiac Rehabilitation program staff or an Exercise Physiologist are best to recommend specific stretches at this stage.

Remember to monitor yourself and STOP and seek medical help if you notice similar symptoms that brought you to hospital the first time.

Secondary Prevention Phase

Following recovery from a heart attack it is more important than ever to keep exercise as a part of your lifestyle and daily routine. Regular exercise will keep your heart and body healthy, help reduce cardiac risk factors and can help prevent heart events in the future. Recommendations are listed below (Figure 3) and include regular aerobic exercise, muscle strengthening and stretching main muscle groups. Exercise Right Australia is a good reference to assist with specific exercise and stretching.

Aim to meet the National Physical Activity Guidelines:

18-64 years, 150-300 minutes of moderate intensity physical activity/week
65 years and over, at least 30 minutes of moderate intensity physical activity on most, preferably all, days. (4)

If you wish to return to a high level of activity, recreational sport, competitive sport or a physically demanding job, obtain the all clear from your physician first.

Always start gradually as you increase activity levels to your pre-heart attack level of activity. Intensity levels at this stage are very individual; however the American College of Sports Medicine recommend exertion can be in the range of light to hard levels RPE 11-16 (2)

Exercise recommendations for older adults

The most successful way to incorporate exercise into your daily routine is to find exercise that you enjoy doing and fits into your day, so it works for you.

Below are some ideas and resources which might help you:

start a home exercise diary
commit to a group, join a gym or sport club i.e. golf, bowls, tennis
set a calendar alarm
swim/water exercise, Yoga, Tai Chi, Cycle, Pilates
Use a Pedometer
Join a local walking group or look at activities at your local community centres
Exercise with a friend
Minimise prolonged sitting and screen time – standing is better than sitting
Buy/borrow a dog to walk
Move every 30 minutes – stand more
Exercise at the same time to build it into your routine
Choose active modes of transport to gain incidental exercise