Physical activity and exercise after a heart attack

Your nurse will tell you how to gradually increase your activity levels whilst you are in hospital, until you are ready to be discharged home.

When home, you should start to regain your normal level of activity steadily over the first six weeks after your heart attack. However, this is a target timescale and some people take longer. The extent of your heart attack, other health problems and your previous level of activity will all affect your recovery time.

It is important to avoid strenuous activity and heavy lifting / pulling / pushing / carrying during the first six weeks. If you wish to return to these activities after 6 weeks, you must discuss this first with your Cardiologist or GP.

There are some suggested timescales on the next pages for carrying out activities during your recovery, but if you have additional health problems you may need to take things more slowly.

If you found it difficult to do some activities before your heart attack, don’t try them now. Take your time and get used to being at home.

1 to 2 weeks after leaving hospital

• Showering / bathing (see page 19 of ‘Life after a Heart Attack booklet’ for more information)
• Computer / desk work for short periods l Cooking light meals and washing up
• No lifting of heavy weights (applicable for at least 6 weeks)
• Light housework (washing a few pots / light dusting)
• Sexual intercourse at about 2-3 weeks if symptoms / fitness allows (see pages 21 and 22 of ‘Life after a Heart Attack booklet’ for more details)
• Straightening bed clothes but avoid changing sheets

3 to 4 weeks after leaving hospital

• Light gardening (removing dead heads from plants, potting)
• Ironing / vacuuming if the vacuum cleaner is light
• Food shopping with trolley for light loads (2 bags)
• Change bedding
• Loading / unloading light loads of washing
• Cooking up to two meals a day

5 to 6 weeks after leaving hospital

• Continue with above
• Shopping, heavier loads (no more than 2 bags)
• Light gardening, planting and weeding for short periods
• Vacuuming but do not carry the vacuum cleaner up and downstairs or move heavy furniture

6 weeks and beyond

• Full shopping load (as long as it is not a ‘heavy’ load)
• Decorating
• Moving furniture with assistance
• Washing car by hand
• Cleaning windows
• Cutting hedges
• Cutting grass
• Continue to build up normal activities

6 weeks after your heart attack you may feel that your activities are as they were before, if not continue to build up your amount of work / activities until you feel you are back to normal (to the level advised by your Cardiologist).

If you feel you are not at the level you should be please do not push yourself. However, you must discuss this with your GP in order to rule out any physical or emotional cause.

As a general rule it is better for people with heart conditions to stay as active as possible. Activity and exercise at the right level can help the heart and other muscles become more efficient and effective, reducing the risk of further cardiac events.

Other benefits of exercise and activity include:

• your heart becoming stronger
• reduction in symptoms. e.g. angina, breathlessness
• increase in energy levels
• help with weight loss
• help reduce cholesterol
• help reduce blood pressure
• increased self confidence and feelings of well being

Most people in the UK do not do enough exercise / activity. Without exercise the body becomes more prone to disease. If you are inactive over a long period of time your heart, which is a large muscle, becomes less efficient and you find it harder to cope with activity. By making a decision to become more active you can make your heart muscle ‘fitter’, meaning the muscle requires less oxygen to do its work and making it easier to carry out day to day tasks, including walking. Therefore being inactive can actually be more of a risk than being active.

Walking is the simplest form of exercise, can be done with friends and family, is free and you can do it straight from your door. It also puts less strain on the heart than upper body activities and so is a good starting point.

During the first 6 weeks after your heart attack you can carry out household tasks and walk short distances, which you should aim to gradually increase. During these activities / exercise you should feel comfortable with only a minimal increase in your breathing rate. You should start and finish them all more slowly, to allow your heart to warm-up and cool down safely.

It is important during the first six weeks to gradually build up your level of activity / exercise around periods of rest, as your heart is still in the recovery stage. If you do too much activity / exercise it may make you feel so tired that you may have to reduce your level of activity / exercise for several days afterwards.

It is very important to always have a period of warming up and cooling down when you are exercising /being active. That is, always starting and finishing your exercise / activities more slowly.

Below are some examples of how to do this.

• If you are exercising / being active for 10 minutes, spend the first 3-4 minutes building up and the last 3-4 minutes slowing down
• If you are exercising / being active for 15 minutes, spend the first 5 minutes building up and the last 5 minutes slowing down
• If you are exercising / being active for 30 minutes, spend the first 10 minutes building up and the last 10 minutes slowing down

Therefore, the amount of time you spend building up and slowing down your exercise / activities is proportional to how much activity / exercise you are doing in total.

It is good to keep a record of your progress with walking and activities.

If you feel able to do so, try to increase your walking time by 5 minutes each week and if able, gradually add in some hills as the weeks progress. However, do not start or finish your walk up hill.

If your walking is limited, then contact the Cardiac Physiotherapist via your Cardiac Specialist Nurse or directly be using the telephone number in the back of this booklet.

The Physiotherapist will be able to give you some exercises to do at home to help improve your mobility and advise you about suitable exercise designed to help you return to specific activities that you identify as being important to you.

• Never exercise / do activities if you feel unwell (especially if you have a temperature, cold or flu), or if you feel very stressed or tired.
• Avoid exercise / activity for 2 hours after a meal.
• Avoid extreme temperatures /weather conditions / altitude.
• Wear appropriate clothing and footwear.
• Pace yourself and don’t compete with others - go at your own pace!
• Carry your GTN spray / tablets at all times (as you should do even when not exercising / being active).
• Avoid smoking for 1 hour before exercise / activity.
• If you are diabetic, take warfarin or have any other health conditions eg. anaemia, thyroid problems, then the information about exercise / activity on this page should be used alongside information from doctors / nurses that you see for these conditions regarding exercise / activity.
• Do not exercise/do activities whilst under the influence of alcohol.

If you experience any symptoms of chest pain (or any other possible angina symptoms) whilst doing exercise / activity then stop immediately and follow the instructions on page 13 of the ‘Life after a Heart Attack’ booklet on how to respond to this.

Please contact your Cardiac Rehabilitation Specialist Nurse or the Cardiac Physiotherapist if you have had to use your GTN spray / tablets during exercise / activities, before returning to exercise / activity again.

If you feel unwell or experience any unfamiliar joint or soft tissue pain whilst exercising or being active, then stop immediately and seek medical advice.

If you experience chest pain / tightness / heaviness / aching at rest (including in bed), use your GTN spray / tablets straight away, as per your protocol on page 13 of the ‘ Life after a Heart Attack booklet’. Do not do any exercise / activity until you have had these symptom medically assessed, treated by your Cardiac Nurse or GP and until you have been advised it is safe to resume exercise / activity.

Six weeks is when the level of intensity of exercise can be reviewed, providing you do not have any outstanding investigations / appointments and you are not waiting for surgery or stents. After getting the all clear from your Cardiologist to progress your exercise and activity, then if you have not had any problems with your walking programme or daily activities, and have built up your walking and activities as advised, you can start to increase the pace or level of exertion of your exercise and activities.

This means you can start to exercise / be active at a pace where you feel slightly breathless, which means you are breathing a little heavier than normal but can still comfortably talk. Your legs / arms should not feel tired at all and you should be able to continue your exercise and activity at this pace comfortably. A brisk walk would be an example of exercise at this pace / level of exertion.

Ideally, you should aim to achieve 30 minutes of exercise / activity per day at a pace of feeling slightly breathless. The good news is that you can accumulate this in smaller amounts of exercise and activity throughout the day, for example 3x10 minutes per day at this pace.

However, it is very important to remember that you still need to do a warm up and cool down each time you do exercise and activity. This means that to achieve 30 minutes of exercise and activity at a pace of feeling slightly breathless, you will need to do more than this in total per day in order to include your warm-up and cool down.

Below are some examples of how this can be achieved.

15 minutes of housework

• 5 minutes building up your pace
• 5 minutes feeling slightly breathless
• 5 minutes slowing down your pace

30 minutes of gardening

• 10 minutes building up your pace
• 10 minutes feeling slightly breathless
• 10 minutes slowing down your pace

45 minutes of walking

• 15 minutes building up your speed
• 15 minutes brisk walking
• 15 minutes slowing down your speed

1 hour of cycling

• 15 minutes building up your speed
• 30 minutes feeling slightly breathless
• 15 minutes slowing down

All exercise and activity should be non-competitive and low impact. However, if you do wish to return to competitive exercise after gradually increasing your exercise levels over the first 12 weeks then it may be possible to do so, but you would need to discuss this first on an individual basis with your Cardiologist, GP or Cardiac Physiotherapist.

If you prefer to exercise in a gym or wish to do weight training, we recommend that you first do the Rotherham Cardiac Rehabilitation exercise programme which runs on a weekly basis for 8 weeks at Badsley Moor Lane. Please ask your Cardiac Rehabilitation Nurse if you would like to be referred to this group, or contact the Cardiac Rehabilitation Physiotherapist directly on the telephone number at the back of this booklet.

This group is also suitable if you feel you would benefit from some supervised exercise.

More detailed information about exercise / activity is available via the Cardiac Rehabilitation Education Programme, which you will be given details of by your Cardiac Rehabilitation Nurse / Practitioner.

Advice and information sheets about swimming & water exercise, golf, using gym equipment, exercise classes, gardening and raquet sports are also available from your Cardiac Rehabilitation Nurse or Physiotherapist on request.

If you decide to join a gym or exercise group in the community, always let the staff or instructors know you have a had a heart attack and check the credentials of anyone offering supervision as a trainer, coach or aerobic instructor.

If you are unsure if an exercise /activity is suitable for you or not, please contact the Cardiac Physiotherapist to discuss this before commencing it. Please discuss with your Cardiac Rehabilitation Physio / Nurse / Practitioner or Cardiologist if you want to swim / do exercise in water, as this will not be suitable for some patients.

After 6 months you can be referred to the Active for Health supervised cardiac exercise programme run at Rotherham Leisure Complex (St. Anne’s), Aston Leisure Centre and Maltby Leisure Centre. This referral would need to be from your GP or the Cardiac Rehabilitation Physiotherapist.

Breathlessness and exercise / activity

Breathlessness and exercise / activity As mentioned above, it is normal for your breathing rate to increase during exercise / activity, as your body needs more oxygen. However, if you are breathless on minimal activity or at rest, Use your GTN spray / tablets straight away as per the protocol on page 13 of you ‘Life after an heart booklet’.

Do not do any further exercise/ activity until you have had this symptom medically assessed and treated by your Cardiac nurse or GP and you have been advised it is safe to return to exercise/ activity.

If you are gasping for breath / cannot talk comfortably / or your legs or arms are tired when exercising / being active, then stop and rest.

If your shortness of breath has not returned to normal in 1 minute then treat this as you would any other possible angina symptom and use your GTN spray / tablets as instructed on pages 13 of the ‘Life after a Heart Attack’ booklet.

Patients with non-manual / physically undemanding jobs may be able to start to return to work from 6 weeks onwards, but it is advisable to discuss this first with your Cardiac Rehabilitation/ Nurse Practitioner or GP.

For those who previously did heavy manual work, it is not advisable to return to this work until at least 3 - 4 months after your heart attack and this would need discussing first with your Cardiologist to ensure this kind of work is still suitable for you. Some people may have to take on lighter duties instead.

For all patients returning to work, if possible it is best initially to return on a phased or gradual basis.

Restrict lifting for the first 6 weeks (see above).

After 6 weeks and if advised you are okay to do so by your Cardiologist, you can progress to lifting at your normal level. However, at this point, the following guidelines still apply.

• Everyone has different capabilities, but it is generally safe if you can lift, pull or push a weight 10 or more times. The weight should not be too heavy. If you are struggling to move a weight, have to hold your breath and brace yourself to move it or you have to grunt or groan to move it, then it is too heavy and should be avoided.
• As mentioned previously, if you need to return to heavy lifting, pulling, pushing or carrying, for example at work, you must discuss this first with your Cardiologist or GP.
• Always warm up for 15 minutes before lifting and then cool down for 10 minutes afterwards, as starting lifting without a warm up can increase your blood pressure quickly putting increased pressure on your heart.

• Always start slowly and with small amounts of exercise / activity, building up your own intensity / pace and duration as you become more used to the exercise / activity, following the guidelines above.
• Keep a record of your daily exercise or activity so you can track your progress.
• Exercise or be active with others (as long as they go at your pace and not vice-versa!).
• Choose an exercise or activity that you enjoy and that you can fit into your everyday life/routine.
• Get a health review from time to time, for example to check your cholesterol levels, blood pressure and body fat
• As long as you are doing the right exercise or activity the right way, then anything is better than nothing, so just do what you can and build up from there!
• Don’t just sit there! Just choosing to stand up instead of sitting down throughout the day has now been shown to have health benefits, which is a great place to start even if you can’t manage anything else.
• Be sensible but think positive!

If you are still unsure or concerned about how much exercise / activity you can do, or about difficulties you experience during exercise / activity then contact either the Cardiac Physiotherapist, Cardiac Rehabilitation Nurses or your GP.

Cardiac Physiotherapist / Nurses
Telephone: 01709 423257

Cardiac Rehabilitation Office
Telephone: 01709 427216 / 01709 427731 / 01709 423257