The importance of exercise

Even if you're aware of the benefits of physical activity after a heart attack, knowing when to start and how much activity or exercise to do can be daunting.

Talk with your doctor before you start to do more physical activity. Ask them about the type and amount of activity that's safe for you. They'll consider your personal needs, abilities, medications, and overall treatment plan.

Ask your doctor to refer you to an exercise-based cardiac rehabilitation programme or the Green Prescription programme for supervised exercise (where available).

Find your nearest support group.

In the first four to six weeks, your focus will be on low levels of activity. The focus should be on short bouts or 'snacks' of activity, becoming more frequent as your recovery, fitness and confidence progresses. Initially you may start by doing several two-to-three minute walks to your neighbour's mailbox throughout the day.

As your confidence and fitness increases, you may increase the duration of each walk. Your aim is to build up to 150 minutes of moderate-intensity exercise per week. It doesn’t matter how you do your 150 minutes. For example, it could be 30 minutes walking on five days of the week or 10 minutes of walking, 10 minutes of cleaning and 5 minutes gardening each day of the week.

Once you're doing 150 minutes a week, you may look to increase the intensity of your activity to make it a little harder. This can be done by adding some hills in to your walk or increasing your speed.

If you've had bypass surgery, you will have to avoid upper body strength training exercises and upper body aerobic activity (such as a rowing machine or cross trainer) until the wound has healed. You will also have to avoid water-based exercise until the wound has healed because of risk of infection. Check with your doctor before starting either of these options.

In the interim you can do lower body resistance exercise or lower body aerobic exercise (other than swimming).

The intensity and duration of your physical activity will depend on a few factors, including:

How long ago you had your heart attack.

• The severity of your heart attack and your heart disease.
• The amount of physical activity or exercise you were doing before your heart attack and your previous level of fitness.
• Any other illnesses or injuries you might have.

It's important to go at your own pace. Listen to your body and watch for any cardiac warning signs such as angina, light headedness or shortness of breath.

If you have been inactive for some time, you should start with small amounts of light physical activity like slow walking or light housework, then gradually increase the number of days and length of time you’re active.

In the early days, even low levels of activity such as walking to your mailbox and back may prove a challenge. But once you're further along in your recovery, you will want to increase the intensity and duration of your exercise. Your aim is to build up to 150 minutes of moderate-intensity exercise per week.

Moderate-intensity activity makes you breathe harder than normal but still able to talk.

It's good to include a variety of exercise. Not only is this better from a health perspective, but variety can make exercise more enjoyable so you'll be more likely to stick to it. Include a variety of aerobic activity and some strengthening activities, such as yoga, Pilates or some kind of resistance training.

Aerobic activity, or cardio, is exercise that increases your heart rate and breathing rate. Most low-to-moderate-intensity exercise will be aerobic. 

Below are ideas for different activities that can help you do enough physical activity and keep it enjoyable. They can be done by yourself or with others and include a mix of aerobic, strength, flexibility, and balance activities. For example:

• brisk walking
• jogging
• carrying shopping
• household jobs like cleaning, vacuuming or mopping
• gardening
• yoga or Pilates
• organised sports
• cycling
• dancing
• weight training
• 'cardio' machines at the gym like the rower, cross-trainer or treadmill
• swimming.

If you suffer from arthritis, joint pain or other medical conditions such as asthma, aerobic exercise can still be achievable and enjoyable.

As well as cardio exercise, it is also good to do some strengthening activities, like yoga, Pilates or resistance training.

Yoga focuses on strengthening muscles and improving flexibility, some more intense forms of yoga may be considered cardio training. Pilates also improves muscle strength and balance, as well as flexibility and endurance. Both yoga and pilates have mental health and relaxation benefits which can help with stress and anxiety.

Resistance training (also known as strength training or weight training) is also useful. One way to do this is to join a programme at your local fitness centre - but it's vital you tell your trainer that you're recovering from a heart attack. If your trainer is unsure about what you can and can't do, put her/him in touch with your doctor. Alternatively you can visit this register of clinical exercise physiologists who are specialised in giving exercise to people with heart conditions.

You can also do strength training at home. Once again it's important to check in with your doctor or nurse before starting any exercises. If you've had open heart surgery you will need to wait 12 weeks and have approval from your doctor before you start upper body exercises. If you want some exercises to do at home talk to your doctor, nurse or cardiac rehab nurse about getting a Green Prescription. You can also refer yourself to the Green Prescription programme.

Warming up and cooling down

A warm-up is important to prepare your body for exercise. When you perform a light warm-up, your body widens its blood vessels which enables better blood flow around the body. If you don't warm up and you start your exercise without preparing your body, you increase the chance of experiencing angina. A warm-up may involve light walking on flat ground for five to ten minutes before increasing the intensity.

You should always do a proper cool-down after exercise. Stretching is best done when the body is warm, so is a great cool-down option. A proper cool-down and stretching can help prevent or minimise any muscle soreness the next day.

You can find some great stretches on the ACC website.

Climate and exercise after a heart attack

It's important you think about the climate you are physically active in. In warm and/or humid environments (like during summer or in a swimming pool), your heart and the rest of your body need to work harder to keep your body cool. One way your body keeps cool is through sweating so it's important you stay hydrated with water to replace this fluid while exercising when it is warm.

Always let your instructor or trainer know you have a heart condition before the exercise class or joining an exercise facility. Always check with your doctor before starting a new type of exercise.

Certain exercises in yoga and/or Pilates classes may be considered unsafe for people with heart disease. You should also be careful while doing certain resistance or weight training exercises. 

The natural response when we try to lift anything heavy is to hold our breath but this can limit blood flow to the heart and may cause light headedness or fainting. Any resistance exercise that forces you to hold your breath while lifting should not be performed or the weight should be reduced.

You also need to take care to ensure your exercise stays at moderate intensity. You should be able to talk while exercising – if you find you can only say a couple of words before needing to gasp for air, the exercise is probably too intense.

Always check with your doctor before starting or resuming competitive spots, or other more intense kinds of exercise.

Aim to gradually build your activity levels. Try to build up to doing at least 150 minutes (2.5 hours) of moderate-intensity physical activity each week. Moderate-intensity activity makes you breathe harder than normal but still able to talk.

This could be:

• 10 minutes of vacuuming, 20 minutes of dancing, 60 minutes of gardening and 60 minutes of walking across one week.

If you're in the early days of recovery, your focus will be on getting back to normal activities. Once you're further through your recovery, you could add regular physical activity into your daily life.

The amount of physical activity you can do will depend on your condition, your level of fitness before your heart event and any other illnesses or conditions you have. 

Always follow the advice of your cardiologist, as they'll know how much exercise is best for you.

Remember any progress will improve your heart health.

You can find more tips and information on our physical activity page.

It’s ok to be a little short of breath, but you should still be able to maintain a conversation. If you experience any of the following symptoms stop and get medical advice:

• chest tightness
• dizziness
• palpitations
• extreme shortness of breath.

It can be normal to experience some muscle soreness after exercising for the first time in a while. If you find this continues for a couple of weeks or you are excessively tired after your exercise sessions, it could be a sign you are overdoing it.

After a heart attack, some people may still experience episodes of angina during physical activity and this can affect their confidence. If you experience angina, it's important that you recognise it and know what to do. You must stop and follow the chest pain/angina action plan. You should also discuss this with your doctor and make sure you carry your medication to treat episodes of angina if your doctor has prescribed this.

Make sure you take your GTN spray with you when exercising.

It's normal to have some shortness of breath with physical activity but it can be hard to know when shortness of breath is at an acceptable level or when it signals something more serious.

One useful way of measuring exercise intensity is to consider your breathing. Moderate-intensity is activity that makes you breathe harder than normal but you should still be able to talk.

If you have extreme shortness of breath, slow down or stop exercising. If your shortness of breath doesn't seem right for the level of exercise you are doing, contact your doctor or health professional.

Even if you don't have a hospital-run cardiac rehabilitation programme in your area, there may still be a local cardiac club you can join for support. These clubs are also useful for people who have completed cardiac rehabilitation and want ongoing support.

A Green Prescription is also a great way to stay motivated.

If you don't have a local cardiac club, find someone else or a group of people who can exercise with you. Having an exercise partner/support person:

• keeps you motivated
• takes your mind off the activity
• reduces any anxiety you may have around being active
• allows you to spend quality time with a family member or friend.

Goal setting is another great way to stay motivated. Make sure you set yourself SMART goals. They are goals which are:

• Specific (rather than saying I'll do more exercise, specify what it is you'll do and when)
• Measurable (use time frames and/or distances such as "I will walk 20mins or I'll walk to the shops and back")
• Achievable (for example, it may not be possible for you to become the next New Zealand 5km national champion, however it may be achievable for you to complete a 5km fun run or walk)
• Realistic (for example, if you set yourself a goal of swimming three times a week, make sure you can realistically get to the pool three times a week, afford the entry fee etc.)
• Time bound (Note when you're going to complete the goal by...e.g. "for the next three months I will...")

An example of a SMART goal is: “I want to be physically active for at least 30 minutes per day, four days a week for the next 10 weeks”.

Arthritis or joint pain

If you have a joint condition such as arthritis, avoiding physical activity is one of the worst things you can do. When you exercise and move the joint, you're using the muscles around the joint. These muscles help to support the joint and reduce the stress on the joint itself. If you don’t use these muscles, with ageing they will reduce in size and strength, making the condition worse.

The best type of exercise for people with joint discomfort is non-weight bearing, low impact such as swimming and cycling. Even the resistance from walking in water can be beneficial for your heart. Low impact exercises such as tai-chi or yoga are also great ways of keeping your muscles and joints active, whilst benefiting your heart health.

Asthma

For those prescribed an inhaler for a respiratory condition such as asthma, it is important you carry this with you when exercising and take it as recommended by your GP. To get the most benefit from the inhaler, you should take your normal dosage 10-15 minutes prior to starting exercise, allowing plenty of time for it to take effect.

Diabetes

If you have been diagnosed with diabetes, you should check your blood sugar levels before and after exercise for the first week or two. For most people, blood sugar will drop during exercise as the body uses the sugar in the blood as 'fuel' for exercise.

The amount the blood sugar level changes during exercise will be different for everyone. It will also be affected by:

• the duration and intensity of the exercise
• your medications (the time you took them and their dosage)
• any food/drink consumed before/during exercise.

It's important not to let your blood sugar get too low (hypoglycaemia) so checking it before exercise will remind you to have a snack before exercising if it's on the low side.

It is important you carry a source of easily absorbed sugar (i.e. sweets) while exercising, in case you feel your blood sugar getting too low. As your exercise becomes regular, you may notice your blood sugar levels become lower more often. If this happens, you may want to discuss with your doctor as you may need to alter your medication.

Note: Those taking insulin are at most risk of hypoglycaemia during exercise and it is strongly recommended you check your blood sugar before and after all exercise sessions.

Any physical activity you can do to reduce and break up long periods of sitting will improve your heart health. 

Here are our tips to sit less and move more:

• Take regular breaks when sitting for long periods, watching TV or working.
• Park your car further away from work, the shops or when dropping kids at school. 
• Use the stairs where possible.
• Return your shopping trolley to the store.
• Walk to the dairy/shops rather than drive.
• Wash your car.
• Stand up and go for a walk or do some stretches during TV ad breaks.
• Get off the bus or train a stop early and walk the rest of the way.