Heart Failure: Exercise


Please talk to your doctor or nurse about the best exercise routine for you. When you have heart failure, you may need to avoid certain exercises or have other restrictions based on your health.

This information is a guide to the overall benefits of exercise for patients with heart failure. This information may or may not apply to you.

Types of Exercise

There are 3 basic types of exercise — flexibility, cardiovascular/aerobic and strength training.

Flexibility. This type of exercise involves slow movement to lengthen the muscles. Flexibility exercises include stretching, tai chi and yoga. They are also used before and after exercising to prevent injury and strain. Benefits include better balance, range of motion and better movement in your joints.

Cardiovascular/aerobic (“cardio”). This type of exercise is steady and uses your large muscle groups. It improves the way your body uses oxygen and has the most impact on your heart health. Examples of aerobic exercises include walking at a fast pace, jogging, riding a bike (outdoor or stationary), jumping rope, cross-country skiing, rowing and low-impact and water aerobics. Benefits include lower blood pressure, lower heart rate and better breathing (since your heart doesn’t have to work as hard when you are active).

Strength training. This type of exercise involves repetitive muscle movement until the muscle becomes tired. Strength training usually involves lifting weights (free weights, weight machines, kettle bells) or using resistance tubes and bands. Benefits are stronger, more toned muscles; stronger bones; weight control (as you build muscle, your body burns more calories); and better balance and posture. Do not use weights heavier than 10 pounds.

Phases of Exercise

All exercise should include 3 phases — warm-up, conditioning, and cool-down.

Warm-up. This phase should last about 5 minutes. It helps your body get ready to exercise, reduces stress on your heart and muscles, and helps prevent sore muscles. A warm-up should include stretching, range-of-motion exercises and starting your activity at a low-intensity level.

Conditioning. This phase should last 20-30 minutes and includes the actual exercise you are doing. You are burning calories and gaining the benefits of exercise.
As you exercise, you should keep track of your intensity level, which is how hard you are exercising. As you get stronger, you can spend more time conditioning and work with greater intensity.

Cool down. This phase should last about 5 minutes. It helps your body recover from the conditioning phase. Your heart rate and blood pressure will slowly return to normal. During this phase, you can decrease the intensity of your exercise and do some of the same stretching you did during your warm-up. Do not sit down without a cool down. This can cause you to feel dizzy or have heart palpitations (fluttering in your chest).

Symptoms and Causes

Symptoms with Exercise

As you exercise, it is normal to feel short of breath, sweat and have a faster heartbeat than normal.When symptoms are not normal:

  • If you get extremely short of breath, weak, dizzy or lightheaded while exercising, slow your pace or rest. While resting, keep your feet up. If your symptoms continue, call your doctor or nurse.
  • If you have a fast or irregular heartbeat, rest and try to calm down. Check your pulse after 15 minutes. If it is higher than 120-150 beats per minute, call your doctor.
  • If you have any type of pain, do not continue that exercise. Talk to your doctor.
  • If you have pain or pressure in your chest, arm, neck, jaw or shoulder, call 911.

Management and Treatment

What are the Benefits of Exercise?

There are many benefits to regular exercise, especially aerobic exercise:

  • Makes your heart and cardiovascular system stronger
  • Reduces your risk of heart disease by lowering blood pressure
  • Helps you reach and stay at a healthy weight
  • Improves your circulation and the way your body uses oxygen
  • Gives you more energy, which lets you be more active without getting tired or short of breath
  • Makes your muscles stronger and more toned
  • Improves your balance and flexibility
  • Reduces joint pain
  • Makes your bones stronger
  • Gets rid of body fat
  • Reduces stress, tension, anxiety and depression
  • Helps you sleep better
  • Improves your self-esteem and body image because you will look and feel better

Exercise Tips

  • Wait at least 90 minutes after eating a meal before you take part in aerobic exercise.
  • Don’t skip the warm-up and cool-down.
  • Balance your exercise with seated activities.
  • Remember to drink water when you are thirsty.
  • Rest as needed during exercise. It is best not to lay down after exercising because it reduces your tolerance.
  • Slowly increase your exercise level, especially if you have not been getting regular exercise. Exercise at a steady pace.
  • Don’t exercise when you are sick or have a fever. Wait a few days to heal. Ask your doctor or nurse if you have questions about when you can return to your routine.
  • Have fun! Choose an exercise you enjoy. Having fun helps you stick with your routine. Think about:
  • The types of exercise you enjoy; choose a variety of activities so you don’t get bored.
  • Whether you like exercising alone or with a group.
  • The types of programs that work with your schedule.
  • Any physical problems that limit your choice of exercise.
  • Your goals for exercise. Besides improving the health of your heart, do you want to lose weight? Build muscle? Improve flexibility?
  • Wear appropriate clothing and shoes to match your activity and weather conditions.
  • Schedule exercise as part of your daily routine. Plan to exercise at the same time every day, and stick with your plan.
  • Think twice about investing in expensive equipment or memberships unless you know you will use them. It is possible to have an effective, inexpensive exercise routine.
  • You may want to find a friend to exercise with to help you stay motivated and on track.
  • Keeping an exercise record will help you see your progress.

Living With

A Walking Program

Walking is one of the most important things you can do to help your health when you have heart failure.

  • Walking improves muscle tone and strength.
  • Walking keeps you from losing endurance and getting weak muscles (deconditioning).
Tips for Walking
  • It is best to walk 20-30 minutes per day, 5 days per week.
  • You can start with 5-10 minutes per day at a slow pace and add time and speed as you get stronger.
  • You should be able to talk while walking.
  • If you are too short of breath, stop for 1-3 minutes and start walking again at a slower pace.
  • If your legs feel weak and tired when walking, stop for 1-3 minutes and start walking again at a slower pace and for a shorter amount of time.
  • Walk at the time of day when you have the most energy.
  • Take it easy when going up hills. Adjust your pace so you don’t get too tired. Remember that the time and distance out will be the same time and distance back.
  • Plan your walks so you don’t get too tired to walk back.
  • A faster-than-normal heart rate, sweating and feeling short of breath (not exhausted) are normal responses when you take part in moderate-to-vigorous activity and exercise.
  • Regular walking is important.
  • Talk to your doctor or nurse if you aren’t sure how fast you should walk.
  • Don’t walk outside if the temperature is below 20 degrees or above 80 degrees Fahrenheit with more than 80 percent humidity. Shopping malls are good places to walk in bad weather.


Questions to ask Your Doctor or Nurse

  • How much should I exercise?
  • What type of exercise is best for me?
  • Should I avoid any exercises?
  • Do I need to take my pulse when I exercise?
  • Do I need to take my medications at a certain time on the days I exercise? Always check with your doctor or nurse about exercise if you have any changes to your medications!
  • Should I start a cardiac rehabilitation (rehab) program? These programs include education and a custom exercise program. They are led by healthcare providers trained to monitor your heart health.

Last reviewed by a Cleveland Clinic medical professional on 11/27/2018.

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