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Heart Failure – Exercise

Why should I exercise?

Regular exercise has many benefits. Exercise, especially aerobic exercise, can:

  • Strengthen the heart and cardiovascular system
  • Reduce heart disease risk factors, such as high blood pressure and being overweight
  • Improve your circulation and help the body use oxygen better
  • Improve your heart failure symptoms
  • Help increase energy levels so you can do more activities without becoming tired or short of breath
  • Improve muscle tone and strength
  • Improve balance and joint flexibility
  • Strengthen bones
  • Help reduce body fat and help you reach a healthy weight
  • Help reduce stress, tension, anxiety and depression
  • Boost self-image and self-esteem
  • Improve sleep
  • Help you feel more relaxed and rested
  • Help you look fit and feel healthy

Talk to your health care provider first

Always check with your doctor or nurse first before starting an exercise program. Your doctor or nurse can help you find a program that matches your level of fitness and physical condition.

Here are some questions to ask
  • How much exercise can I do each day?
  • How often can I exercise each week?
  • What type of exercise should I do?
  • What type of activities should I avoid?
  • Should I take my medication(s) at a certain time around my exercise schedule?
  • Do I have to take my pulse while exercising?
Cardiac rehabilitation

Your doctor or nurse may encourage you to participate in the hospital’s cardiac rehabilitation (rehab) program. A cardiac rehab program is designed to help you exercise safely and maintain a heart-healthy lifestyle. The program generally includes:

What type of exercise is best?

Exercise can be divided into three basic types:

1. Flexibility (and warm-up): Slow lengthening of the muscles. Stretching the arms and legs before and after exercising helps prepare the muscles for activity and helps prevent injury and muscle strain. Flexibility exercises include stretching, tai chi and yoga. These exercises allow you to have better balance, a better range of motion, and keep your joints flexible.

2. Cardiovascular or aerobic: Steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body’s ability to use oxygen.

Aerobic exercises include: walking, jogging, jumping rope, bicycling (stationary or outdoor), cross-country skiing, skating, rowing, and low-impact aerobics or water aerobics.

3. Strengthening: Repeated muscle contractions (tightening) until the muscle becomes tired.Strength Training involves lifting weights or using resistance (resistance tubing or bands, for example) to strengthen the skeletal muscles.

How often should I exercise?

In general, to achieve maximum benefits from exercise, you should gradually work up to an aerobic session that lasts 20 to 30 minutes, at least 5 times a week.

What should I include in my program?

Every exercise session should include a warm-up, conditioning phase and a cool-down.

The warm-up (five minutes) helps your by adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowing increases your breathing, circulation (heart rate) and body temperature. It also helps improve flexibility and reduce muscle soreness.

The best warm-up includes stretching, range of motion activities and the beginning of the activity at a low intensity level.

The conditioning phase (20-30 minutes) follows up the warm-up. During this phase, the benefits of exercise are gained and calories are burned. During the conditioning phase, you should monitor the intensity of the activity.

The intensity is how hard you are exercising.

Over time, you can work on increasing the duration of the activity. The duration is how long you exercise during one session.

The cool-down phase (5 minutes) is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean to sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy, lightheaded or have heart palpitations (fluttering in your chest).

The best cool-down is to slowly decrease the intensity of your activity. You may also do some of the same stretching activities you did in the warm-up phase.

General exercise guidelines

  • Wait at least 90 minutes after eating a meal before aerobic exercise.
  • Gradually increase your activity level, especially if you have not been exercising regularly.
  • Remember to have fun! Choose an activity that you enjoy — exercising should be fun and not a chore. You’ll be more likely to stick with an exercise program if you enjoy the activity. Here are some questions you can think about before choosing a routine:
    • What physical activities do I enjoy?
    • Do I prefer group or individual activities?
    • What programs best fit my schedule?
    • Do I have physical conditions that limit my choice of exercise?
    • What goals do I have in mind? (losing weight, strengthening muscles or improving flexibility, for example)
  • Warm up. Take time to include a 5- minute warm-up, including stretching exercises, before any aerobic activity.
  • Cool down. Include a 5-minute cool down after the activity. Stretching can be done while standing or sitting.
  • When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
  • Dress for the weather conditions and wear protective footwear.
  • Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so that you do not get bored.
  • Exercise at a steady pace that is effective.
  • Exercise does not have to put a strain on your wallet. Think twice before buying expensive equipment or health club memberships unless you are certain you will use them regularly. There are plenty of other activities that can be done with no extra cost to you (e.g., walking).
  • Stick with it. If you exercise regularly, it will soon become part of your lifestyle. Make exercise a lifetime commitment. Finding an exercise "buddy" will also help you stay motivated.
  • Keep an exercise record. This will allow you to see your progress.
  • Always ask your doctor or nurse before starting or changing your exercise program.
  • Before continuing your regular exercise program, speak with your doctor or nurse if changes have been made in your medications. New medications can greatly affect your response to activity.
  • Pace yourself and balance your activities with rest.
  • Know your limits.  Lifting should be limited to 10 pounds.  Ask for help when you  need it.
  • Aerobic exercises are best; these are activities such as walking, cycling and swimming.  Push-ups and sit-ups may cause too much muscle strain. 
  • Rest when you need to, but try not to lay down after exercise, as it reduces exercise tolerance. 
  • Avoid exercising outdoors when it is too cold, hot or humid. High humidity may cause you to become fatigued more quickly, and extreme temperatures can interfere with your circulation, make breathing difficult and possibly cause chest pain. Instead, try indoor activities such as mall-walking. Avoid extremely hot and cold showers or sauna baths after exercise.
  • Adjust your pace if walking in hilly areas so as to not overexert yourself. 
  • When there has been an interruption in your exercise schedule, resume at a lower level and gradually build back up to your best level.
  • When you are ill or feverish, wait a few days until your symptoms resolve before resuming your exercise routine.  Allow your body time to heal, unless your doctor or nurse gives you other directions.
  • If you are short of breath during any activity or have increased fatigue, slow down your activity level or rest. Keep your feet raised or elevated when resting. If you continue to have shortness of breath, call your doctor or nurse. Changes may be made in your medications, diet, or fluid restrictions.
  • If you develop a rapid or irregular heart beat or have heart palpitations, rest and try to calm yourself. Check your pulse after you rest for 15 minutes.  If your pulse is still above 120-150 beats per minute, call your doctor or nurse for further instructions.
  • Do not ignore pain. If you have chest pain or pain anywhere else in your body, do not continue the activity. If you perform an activity while you are in pain, you may cause stress or damage on your joints. Ask your doctor or physical therapist for specific guidelines. Learn to "read" your body and know when you need to stop an activity.
  • Stop exercising and rest if you:
    • Have chest pain
    • Feel weak
    • Are dizzy or lightheaded
    • Have pressure or pain in your chest, neck, arm, jaw, or shoulder
    • Have any other symptoms that cause concern

Call your health care provider if these symptoms do not go away.

General guidelines while performing these exercises:

  • Maintain good posture while performing these exercises - keep your back straight. Do not curve or slump your back.
  • Make sure your movements are controlled and slow - avoid quick, jerking movements. Do not bounce.
  • Do not hold your breath during these exercises.

If any of the following exercises causes pain, stop the activity and seek the advice of a physician, nurse or physical therapist.

Ankle Pumping/Leg Circles


Ankle Pumping/Leg Circles

Sit with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five. For leg circles, rotate leg clockwise, the counterclockwise, as if drawing small circles. Repeat.

Knee Straightening


Knee Straightening

Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Alternate legs. Repeat.

Hip Bending


Hip Bending

Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting). Repeat.

Overhead Reaching


Overhead Reaching

Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Alternate arms. Repeat.

Single Shoulder Circles


Single Shoulder Circles

Bending one elbow, put your fingertips on your shoulder and elbow clockwise, then counter clockwise. Repeat each direction with each arm.

Single Arm Lifts


Single Arm Lifts

Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm. Repeat with both arms.

Calf Stretch Against Wall


Calf Stretch Against Wall

Stand facing the wall with your hands against the wall for support. Put one foot about 12 inches in front of the other.

Bend your front knee, and keep your other leg straight. (Keep both heels on the floor). To prevent injury, do not let your bent knee extend forward past your toes.

Slowly lean forward until you feel a mild stretch in the calf of your straight leg. Relax, then repeat with your other leg. Repeat.

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

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