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Module 5: Exercise and Activity with Heart Failure
One of most important ways that people with heart failure can maintain their sense of well-being is to keep active. In the past people with heart failure were advised to rest and give up many of their usual activities. But recent research has shown that activity including exercise, work, and sex is healthy and safe for most people with heart failure. Activity can help you feel better, may decrease your symptoms, and may improve your heart's function. By keeping active, you may be able to do more of the things that you enjoy.

Even if you have never been active and are not very confident about your physical ability, you can take steps to become more active. However, be sure to talk to your doctor or nurse before starting an exercise program or increasing your activity level.

Cardiac rehabilitation is a structured program offered at many health care centers. It offers specialized staff to help you exercise safely,
undergo frequent monitoring of your condition, and learn how  to maintain a heart healthy lifestyle. Check with your health care provider about whether you can benefit from a referral to a cardiac rehabilitation program.

This module provides information on:

  • The benefits of activity.
  • Starting and maintaining an activity or regular exercise program.
  • How to conserve energy while doing everyday activities.
  • Going back to work.
  • Sexual activity and heart failure.

It will help you:

  • Build up your activity level.
  • Do more around the house.
  • Make an informed choice about employment.
  • Stay sexually active.
Becoming More Active With Heart Failure

The key to becoming more active is to do it slowly and gradually. This is especially important if you have not been active on a regular  basis, or if you have stopped being active because of illness.  To start, pick a simple aerobic activity that you like. An aerobic  activity is one that involves moving the large muscles. Some  examples include walking, bike riding, even using the elliptical  machine at the gym. A great way to become more active is to  start doing activities or hobbies that you may have stopped.  Examples include biking, swimming, gardening, bowling, or any  activity that you enjoy that keeps you moving. It is a good idea to  include walking in any activity plan that you develop. Walking is a  good choice for many people because it is easy to start a walking  program, does not require any special equipment, and can be  done year-round and most anywhere.  If you are going to start a more vigorous exercise program to become more physically fit, or if you have more symptoms with  activity, be sure to talk to your health care provider. They may
want to do an exercise test before you start such a program. This  can be as simple as walking on a treadmill while being monitored.  You may want to start getting more active in a supervised setting  under certain conditions:

  • If you or your health care provider have any concerns about your abilities.
  • If you are really out of shape.
  • If you usually have symptoms like shortness of breath or tiredness even  when you do mild activity or are at rest.

Discuss this decision, or any of your concerns, with your health  care provider. Usually, you and your health care provider can come  up with a safe activity plan.

To make it easier to continue with your activity, try to find a place  where you can be active indoors such as a local gym or fitness  center in addition to your outdoor activities. That way you will  not have to skip being active when it is too hot or cold or when it is raining. Find out if the gym or fitness center has an indoor  track, swimming pool, or stationary bike you can use. Or arrange  to walk at a local mall. Walking outdoors is also great when the  weather is pleasant.

The goal for most people with heart failure is to accumulate at least  30 minutes of activity per day on most days of the week. This does  not mean that you have to be active for 30 minutes in a row, if that is  difficult for you. For example, you can be active for three 10-minute  blocks to get to your 30-minute goal.

Whatever activity you choose, remember to start slowly. Move at a  pace that is comfortable for you. You can start being active with as  little as 5 minutes a day of walking. This may not seem like much,  but it is a good start. Be sure to listen to your body. The goal is  to increase your activity slowly over time. Doing it quickly may be  unsafe or can lead to frustration. With time and patience, you will  be surprised at how much you will be able to do after a while.

If walking seems like too much activity for you to start with, talk  with your health care provider. They may talk to you about leg or arm exercises to do while you are sitting.

Warming Up and Cooling Down

It is important to spend a few minutes warming up and cooling down before and after each activity session to avoid injuring yourself and stressing your heart. Warming up helps your body and your heart adjust to the increased demands of activity. It also stretches tendons and muscles to avoid cramping. Cooling down allows your heart rate, blood pressure, and other body functions to return to their usual resting levels and brings down your adrenaline level gradually. Most of the problems that people have related to activity occur when they stop the activity suddenly and do not take the time to cool down slowly and correctly.

Warming Up

Spend 5 minutes warming up before you begin an activity or exercise program. One of the best warm-up exercises is to do  your intended activity very slowly (that is, if you are going to walk,  walk slowly for the first 5 minutes; if you are going to ride a bike,  pedal slowly without resistance for the first 5 minutes). Some patients may stretch before they exercise, but you should first discuss this with your health care provider, and they will suggest specific stretching exercises for you.

Cooling Down

The best way to cool down is to slowly decrease the intensity of the activity or exercise you are doing. For example, if you are walking, walk more and more slowly for the last few minutes of your exercise session. Never stop exercising suddenly and just sit, lie down, or stand still. It can make you feel dizzy or lightheaded. End your activity program by doing about 5 minutes of stretching exercises.

Strength Training or Muscle Building

People used to think that only young and healthy athletes did strength training to build up their muscles. But we now know that everyone should stay strong. If you build your muscles, you may have more strength to do your usual activities. For example, you will more easily be able to brush or comb your hair or do other activities that require you to hold your arms over your head. A safe way for people with heart failure to build up their arm muscles is to learn stretching exercises using the large elastic bands that are commercially available. Ask your health care provider about where to get these and how to use them.

Other Tips and Guidelines for Activity

As you build regular activity into your life, consider the following:

  • Get walking shoes that fit comfortably and have good support.
  • Wait one hour after a light meal to exercise. Do not exercise on either an empty or a full stomach.
  • Avoid activities or exercising outdoors when it is colder than 40°F or warmer than 80°F or on high smog days.
  • Always warm up and cool down with stretching and slow walking.
  • Start any activity at a slow and steady pace.
  • Do not hold your breath when walking, exercising, or doing any kind of physical activity.
  • Exercise or do your selected activity at the time of day when you feel most energetic. For most heart failure patients that is the morning.
  • The day after you are more active, you may feel more tired than usual.
  • Although this is common, make sure you talk to your health care provider if this tiredness lasts longer than a day.
  • Consider being active with a partner. Studies have shown that people stick to their activity program and enjoy it more when they have a partner.
  • Make sure that you can carry on a conversation while you are doing any activity. If you cannot carry on a conversation, you are exercising too hard
    and need to slow down.
When You Should Not Be More Active

Although regular activity is good for you, you should not be more active at certain times. Do not exercise or increase your activities when you:

  • Have shortness of breath at rest or more symptoms than usual.
  • Feel exhausted.
  • Have a fever, infection, or feel ill.
  • Have chest pain.
  • Are going through a major change in your medication regimen.
  • Have persistent muscle aches or pains in the body part you are exercising.

During activity, watch for signs of overexertion that may be due to your heart condition. Signs of overexertion include:

  • Shortness of breath that prevents you from completing a sentence.
  • Shortness of breath that does not get better when you decrease or stop the activity.
  • Dizziness or lightheadedness.
  • Chest pain or tightness. Pain in your arms, shoulders, neck, or jaw.
  • Irregular heart rate (pulse).
  • Unusual or extreme fatigue.
  • Severe sweating.
  • Nausea, vomiting.

If you have any of these symptoms while being
active, slow down. If the symptoms do not get
better, stop the activity. Call 911 if your chest
pain or other symptoms are not relieved.

Doing More of What You Enjoy

As you become more active, you will notice that you have more energy for activities around the house, hobbies, and other kinds of recreation. Even though staying active is good, you may still find it hard to do as much as you did before. The following tips can help you do more:

  • Allow for rest periods during the day.
  • Do not wait until you are exhausted to rest. Alternate rest periods with activities, so that you can get more done.
  • Use slow and smooth flowing movements during activities. Rushing increases fatigue and discomfort.
  • Avoid activities that require quick spurts of energy.
  • Use good posture.
  • Avoid activities when it is too hot or too cold or immediately after a meal.
  • If there is a particular activity you want to do on a certain day, plan ahead and schedule it for a time you usually feel at your best. Most people feel more energetic in the morning, but others feel at their best in the afternoon. Listen to your body to figure out when to do a demanding activity.
Other Ways to Conserve Energy So You Can Be More Active

If you do everyday activities in ways that conserve energy, you will be able to get more done. Try the following techniques to conserve energy:

  • Pull heavy objects instead of pushing them.
  • Put a tall stool in the kitchen, so that you can sit while preparing food and cleaning up if you get tired.
  • If you are standing while doing an activity, make sure you work at waist level, so that you do not have to reach too high or bend over too low.
  • Place heavier objects that you use often at waist level. For example, in the kitchen, place plates and heavy pots or pans on shelves that are at waist level.
  • If you have stairs in your house, plan ahead, so you do not need to make as many trips up and down.

There is no reason to stop working just because you have been diagnosed with heart failure. In fact, working can help decrease feelings of isolation and depression. It can also help your finances. At first you may feel that working is impossible, especially if you have a lot of symptoms or have been
hospitalized. So, it may be helpful to avoid making long-term decisions about work until your medical therapy is optimized and you are feeling better.

It can be helpful to think about work as a type of physical activity. You may have to slowly increase the number of hours you work to help your body adjust, especially if you have a physically demanding job, or if you have taken time off recently. It may also be necessary to modify your job, so that you can return to it successfully.

If you have a job where you sit a lot of the time, you probably will be able to return to it without many changes. But if you have a job that requires physical labor, you may need to move to a less strenuous one. Similarly, if your job is mentally demanding and stressful, you may have to figure out a way to decrease the stress.

If you cannot return to your usual job, you might check with your employer to see if you can work part-time or at light duty. Each person’s situation is different. But use the following guidelines to help make decisions about work:

  • Postpone going back to work until your symptoms stabilize and your medical therapy has been adjusted to its optimal level.
  • Increase your stamina by working on your activity program. Then you will have more energy to do your job.
  • If you have had to limit your activities because of heart failure, consider going back to work half time and working up to full time.

You should also talk to your health care provider about returning to work. He or she may want to perform an exercise test that simulates the intensity of your work to see how well you do. Although many people with heart failure can continue to work in some capacity, some people will not be able to do so. People
with advanced heart failure, such as those with symptoms at rest or with minimal exertion, often cannot work and may be eligible for disability. If you cannot return to work, ask your health care provider or social worker about the level and duration of disability.

You may be eligible for benefits through either your employer or Social Security.

Sexual Activity

Many people with heart failure wonder if they can still have sex.  The answer is yes. Sexual activity is not dangerous to your heart.  Although sex may not be as easy as it once was, it can still be  rewarding. Just as with any other activity, you should not have sex if  you are feeling ill, are very short of breath, or are having chest pains.  To increase your ability to enjoy sex, try the following:

  • Talk openly with your partner about each of your sexual needs and concerns.
  • Pick a time for sex when you feel rested and comfortable, and are not pressured.
  • Avoid sex after eating a big meal or drinking alcohol.
  • Have sex in a comfortable room that is not too hot or too cold.
  • Use foreplay to help your heart get used to the increased activity level of intercourse.
  • Avoid positions in which you support your weight with your arms.
  • Have sex in less strenuous positions such as lying on the bottom or with you and your partner lying side by side.

If intercourse is difficult for you, try to find other ways of being physically close and intimate with your spouse or partner. For example, consider:

  • Finding other ways to show affection.
  • Trying mutual forms of sexual stimulation other than intercourse.
  • Increasing nonsexual affection and communication with your spouse or

Also keep in mind that people with heart failure may have problems with sex including decreased sex drive, problems with ejaculation, impotence, or inability to have an orgasm or climax. If you are having sexual difficulties, do not hesitate to talk with your health care provider. Often your health care provider will not bring up the topic of sex, but you should feel free to bring it up at any time.

Personal Goals

As you read this booklet and try to stay active, think about a personally meaningful goal. For example, you may have given up enjoyable activities such as walking around the neighborhood with your spouse or walking the dog since being diagnosed with heart failure. Or you may have stopped fishing with your family or walking to church on Sunday.

Make plans to do activities that you enjoy and that are meaningful to you using the suggestions in this module. You will feel better both physically and mentally.

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