Features February 2016 Issue

Be Smart About Exercise if You Have Or Are at Risk of Having Heart Failure

Knowing what to look out for and how to manage your workouts will help keep you safe.

Any type of heart condition requires some precautions and common sense when you’re ready to exercise. This is especially true for people with heart failure, because the heart has been weakened and cannot meet the body’s higher demand for blood during physical activity.

But exercising is as important for people with heart failure as it is for anyone else. And if you’re at risk for heart failure, workouts that can strengthen the heart are particularly valuable.

So what should you know about exercising with heart failure?

“Intensity (or difficulty level) of exercise is the concern with people who have heart failure,” says Michael Crawford, manager of the Cardiac Rehabilitation Program at Cleveland Clinic. “When starting out, begin with moderate exercise that makes you breathe a little harder but can still carry on a conversation with someone. Some high-intensity exercise may lead to problems with heart rhythm or remodeling of the heart.”

tennis exercise


You may have to reduce the intensity of exercise with heart failure, but activity is still important.

Approach with Caution

Given the concern about the dangers of exercise with heart failure, you would be wise to get professional guidance when starting an exercise program. Start with a conversation with your doctor. This is good advice no matter what your health issues are.

You may be recommended for cardiac rehabilitation, a structured program of exercise education aimed at helping heart patients learn the skills necessary to live and thrive with conditions such as heart failure or coronary artery disease.

Unfortunately, many heart failure patients still don’t take advantage of cardiac rehab, even though it could benefit them greatly.

A 2015 study found that just 10 percent of heart failure patients eligible for cardiac rehab actually get referred by their physicians to such programs.

“Heart failure was added as an approved diagnosis for cardiac rehab just a few years ago, and may not be widely known as an eligible diagnosis,” Crawford says.

He adds that the criteria for heart failure patients is very specific, so some individuals who could benefit from rehab may be just outside the approved parameters.

“Some additional factors that influence reduced participation include transportation issues, financial issues, complexity of care for congestive heart failure, and in some areas, poor patient compliance with medical care, Crawford says.

If you don’t qualify for cardiac rehab, you may still benefit from a supervised exercise program. Your doctor may write an exercise prescription for you to get at-home sessions with a physical therapist or attend exercise classes at a local hospital.

Before you embark on a new exercise regimen, be sure to find out as much as you can about your condition. Know how your heart failure is classified. Heart failure is divided up into classes based on symptoms and on how limited you are in daily activities because of your condition. The more you know about your heart failure—or your risk of heart failure based on your current heart health—the easier it will be to work with a cardiac rehab or exercise specialist in planning a workout program just for you.

Getting Started

When you’re ready to start exercising, understand your limits and the benefits of various types of exercise. Lifting weights can help build muscle mass, but it won’t give your heart and lungs the workout that a brisk walk can.

treadmill trainer for heart patients


Supervised exercise is at the core of cardiac rehab.

“Most types of exercise are fine, but remember that the cardiovascular benefits come from aerobic exercise, such as walking, cycling, and swimming,” Crawford says. “To help improve strength, try low-resistance with higher-repetition weight lifting. Do sets of 10 to 12 reps. Remember to always breathe when lifting weights. Never strain, and lift in a smooth controlled rate, taking two to three seconds for each repetition. Resistance exercises can be done with resistance bands, free weights, machines or even your own body weight.”

If you’ve moved beyond a formal, supervised exercise program, try to work out with a partner. Another person can help keep you motivated and add a social element to your workout. A spouse or friend who knows about your heart condition can also look for signs of trouble or get help if you need it.

What to Watch Out For

Anyone exercising, whether it’s someone training for a marathon or someone coping with heart failure, needs to pay attention to signals from the body. Chest pain and lightheadedness should be a sign to stop exercising.

Hydration is also important when exercising, but if your doctor has advised you to limit fluids, ask about what you should do when working out. Fluid build-up is a symptom of heart failure, and it can put an additional burden on your heart, while raising your blood pressure.

“Pay attention to rapid changes in weight,” Crawford says. “If your weight increases by three pounds in one day or five pounds over two days, this is a sign of holding on to fluid. Other things to look for are increasing shortness of breath, especially at the same level of exercise, and reduction of exercise ability when staying consistent with your routine.”

Dizziness with exercise, or having palpitations, are also signs you should stop and inform your doctor. And chest discomfort of any kind should be reported to your doctor whether you’re on your couch or a treadmill. These signs don’t always indicate heart trouble, but it’s best to be sure.

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