A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it's a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. It can:

• Strengthen your heart and cardiovascular system.
• Improve your circulation and help your body use oxygen better.
• Improve your heart failure symptoms.
• Increase energy levels so you can do more activities without becoming tired or short of breath.
• Increase endurance.
• Lower blood pressure.
• 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.
• Make you feel more relaxed and rested.
• Make you look fit and feel healthy.

How Do I Get Started?

Always check with your doctor first before starting an exercise program. Your doctor 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?

What Type of Exercise Is Best?

Exercise can be divided into three basic types:

• Stretching: 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. Regular stretching also increases your range of motion and flexibility.
• 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 exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing (since your heart won't have to work as hard during exercise).
• Strengthening: repeated muscle contractions (tightening) until the muscle becomes tired. For people with Heart failure, many strengthening exercises are not recommended. (See below)

What Are Examples of Aerobic Exercises?

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

How Often Should I Exercise?

In general, to achieve maximum benefits, you should gradually work up to an aerobic session lasting 20 to 30 minutes, at least three to four times a week. Exercising every other day will help you keep a regular aerobic exercise schedule.

What Should I Include in My Program?

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

• Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly 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.
• Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. Be sure to monitor the intensity of the activity (check your heart rate). Don't over do it.
• Cool-down. This 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 or 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.

What Is the Rated Perceived Exertion Scale?

The Rated Perceived Exertion (RPE) scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) would be how you feel at the end of an exercise stress test or after a very difficult activity.

In most cases, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

How Can I Avoid Over Doing It?

Here are a few guidelines:

• Gradually increase your activity level, especially if you have not been exercising regularly.
• Wait at least one and a half hours after eating a meal before exercising.
• When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
• Take time to include a five-minute warm-up, including stretching exercises, before any aerobic activity and include a five- to 10-minute cool down after the activity. Stretching can be done while standing or sitting.
• Exercise at a steady pace. Keep a pace that allows you to still talk during the activity.
• Keep an exercise record.

How Can I Stick With It?

• Have fun! Choose an activity that you enjoy. 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? (For example, losing weight, strengthening muscles or improving flexibility.)
• 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. If you exercise regularly, it will soon become part of your lifestyle.
• Find an exercise "buddy." This will help you stay motivated.

Also, exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.

Exercise Precautions for People With Heart Disease

• Call your doctor if changes have been made in your medications before continuing your regular exercise program. New medications can greatly affect your response to activity.
• If you are too tired and are not sure if it is related to overexertion, ask yourself, "What did I do yesterday?" Try to change your activities by starting out at a lower level today (but do not exercise if you are feeling very overtired). Pace yourself and balance your activities with rest.
• Avoid heavy lifting, pushing heavy objects and chores such as raking, shoveling, mowing and scrubbing. Chores around the house may sometimes be tiring, so ask for help.
• Ask your doctor if you can participate in these activities: weightlifting, weight machines, jogging or swimming.
• Avoid push-ups, sit-ups and isometric exercises. Isometric exercises involve straining muscles against other muscles or an immovable object.
• Avoid even short periods of bed rest after exercise since it reduces exercise tolerance. If you become overly fatigued or short of breath with exercise, take a rest period in a comfortable chair.
• 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 can cause chest pain. Instead, try indoor activities such as mall walking.
• Avoid extremely hot and cold showers or sauna baths after exercise.
• Do not go up steep hills during your activity, whenever possible. If you must walk on a hilly area, slow your walking pace when going uphill to avoid working too hard. Watch your heart rate closely and change the activity as needed.
• Reduce your activity level if your exercise program has been interrupted for a few days (for example, due to illness, vacation or bad weather). Then, gradually increase to your regular activity level as tolerated.
• Do not exercise if you are not feeling well, or have a fever. Wait a few days after all symptoms disappear before starting your exercise program, unless your doctor 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. Your doctor may make changes in your medications, diet or fluid restrictions.
• If you develop a rapid or irregular heartbeat or have heart palpitations, rest. Check your pulse after you rest for 15 minutes -- if your pulse is still above 120-150 beats per minute, call your doctor 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.

Warning

Stop exercising and rest if you have any of the following symptoms:

• Chest pain
• Weakness
• Dizziness or lightheadedness
• Unexplained weight gain or swelling (call your doctor right away)
• Pressure or pain in your chest, neck, arm, jaw or shoulder or any other symptoms that cause concern.

Call your doctor if these symptoms do not go away.

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