Exercise Intensity for a Heart Patient

After having a procedure done whether it be open heart surgery, angioplasty, valve replacement etc, the question is how hard can I exercise?

Depending on your procedure, exercise time may very. It really comes down to your doctors discretionon when you can resume moderate activity .

However, once you have been given the green light on exercise, how hard can you really push yourself? In the back of most peoples minds is the worry of having the a heart attack come on again which is a very normal response.

The way I like explaining it to patients is to think of it as rehabilitating a knee injury. If going to physio right after knee surgery, you wouldn’t start off by squatting 100lbs on your back. You would gradually progress from passive exercises laying down, to active exercises sitting up, to body weight exercises etc.

The same holds true for the heart. We don’t want you to try to run a marathon right after your heart attack, but we do want you to slowly start building it’s capacity back up through sustained exercise that is tolerable for the individual.

The first thing I would like to explain is the Borg scale. This scale is a self perceived exertion scale which states how hard the exercise feels for you. A 2 on the scale is “Light” a 3 is “Moderate” a 4 is “Somewhat hard” and a 5 is “hard”.

Now what do these numbers mean? Exercising and giving it a 2 is very light work. You should be able to sing no problem when exercising at this capacity. This is the intensity I like having my patients warm up and cooldown at. I will even ask them to sing during the warm up for 10s and if they can’t I will get them to slow down. This is also a good pace to maintain if you are just starting in your recovery process after having a heart procedure.

Now for the actual exercise portion after completing warm up, we want to increase intensity. You are sweating a bit, breathing a bit harder and you can’t sing at this point, but if I wanted you to you are able to still talk to me. This is known as the talk test, can you still carry out a conversation without being completely out of breathe. This is the pace you should be exercising at after you complete your warm up. I will periodically ask the patient to talk to their friend, spouse etc when exercising and if they can’t, they are to slow down their pace.

We will go into specific duration and breakdown of the exercise continuum in another post, but I just wanted to clear up how hard you should be pushing yourself when exercising as a heart patient.

So our 2 rules of thumb for exercise intensity are:

During warm up, does it feel like a 2 or “easy” on the Borg scale and are you still able to sing if you had to? If not, you should be lowering your intensity.

Secondly after warm up, when in your main exercise phase, can you still carry out a conversation during exercise if you had to? Does it feel like a moderate to somewhat hard pace? If you can’t talk then you need to slow your pace down.

At any point during exercise if chest tightness comes on, dizziness, shortness of breathe etc. you should stop the exercise and rest. If it doesn’t subside, make sure to call 911 and get to the hospital.

Always remember to have proper clearance from a doctor before commencing in any exercise programs and if you require monitoring during exercise be advised to have a trained professional working with you.