Did you know you probably already completed phase I of cardiac rehabilitation? When the hospital staff got you up and walked you down the hall, and gave you some basic education about attending cardiac rehabilitation that was phase I. Now that you are home phase II involves attending a cardiac rehabilitation program. To find a program near you go follow this link: http://www.aacvpr.org/
We know that approximately 30% of patients who should attend rehabilitation do. There are multiple reasons patients don’t. Often it is inconvenient with work schedule, too far or costly to travel. Women and minorities are even less likely to attend for a variety of reasons. If you are not attending you are not alone, but this site can get you started with the basics.
Exercise improves the blood flow to the muscles which over time the heart adapts to and becomes more efficient, requiring less effort to pump. Exercise should initially not be hard or leave you feeling weak or exhausted. It is recommended you find a level that feels fairly light, something you can do for several minutes. That might mean 5 minutes for some people and for others might mean 10 or 15 minutes. Start light, for the first week when you finish your exercise you should feel like “I could have done more”. You should be able to carry on a conversation and not be breathless. We call this the talk test. If you can’t converse without huffing and puffing you are overdoing it.
What kind of exercise is best? Something you will stick to. Something that is repetitious. It could be walking, biking, exercise equipment such as rower, stepper, , elliptical. You may have restrictions if you had open heart surgery and not be able to do any pulling or pushing greater than 10 lbs, this may mean not using a rowing machine and usually you are not allowed to swim until your scar is well healed.
The first goal with exercise is to build duration – or the time you can exercise. Start slow…don’t try to get a whole month’s worth in the first week. Your body is using lots of energy to heal, get used to new medications, adapt to a changed diet and probably poor sleep. Give your self time to build up. Make a goal of adding 5-10 minutes in the first week or two. A goal is to work up to 150 minutes per week, which can mean 30 minutes 5 times a week, or 60 minutes 3 times per week. Remember it is all about doing something rather than nothing. Don’t sell yourself short 10 minutes a day is better than none.
When you have built the time up then gradually build the intensity – or how hard you train. Not every day is a record setting day. If you increased the intensity don’t build again for another week or two. Let your body adapt to what you are currently doing before increasing again. When you increase the intensity do it mid way through the exercise, not at the start or sprinting it out at the finish as this is dangerous. The increase shouldn’t make the exercise feel hard – maybe somewhat hard – such that you can do it for a little while as in 5 or 10 minutes worth and then have to back down to previous level.
Warm up and cool down are CRITICAL. The first 5-10 minutes of exercise should feel like a waste of time, like you aren’t accomplishing anything. This allows the muscles including the heart muscle to get ready for heavier work. It causes the arteries – which carry the blood to the muscles to dilate which means to widen. If the arteries are wide they carry more blood to the exercising muscle and put less effort on the heart. Remember blowing up those kids balloons that you can twist into animal shapes that is the effort your heart has to go through if you don’t warm up…..my cheeks hurt just thinking about it. Another analogy I often use is to compare your body to a classic car sitting in your garage. You wouldn’t pull it out of the garage and rev the motor hard, you would let it idle and warm up to get the fluids moving, well your body works the same way. Cool down is the same way, don’t go from strenuous exercise to suddenly resting, it is hard for the heart to make this transition, often this is when electrical issues crop up or the blood pressure drops. Cool that engine, idle it by slowing back down, doing some stretching. If you have to sit and rest frequently move your legs, tap your toes, lift your legs, this helps to move the blood around which keeps it from pooling and making you light headed.
So that is the basics of aerobic exercise. We will talk about weight training another day.