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Introduction
This Activity and Exercise Guide, along with the Heart and
Stroke Foundations Recovery Road, will help you recover
after your heart attack, angina, angioplasty or cardiac stent
insertion. You will get a copy of Recovery Road from your
nurse before you go home.
If you have been diagnosed with heart failure, please refer to the Living
Well with Heart Failure booklet for activity and exercise information for
you.
If you have recently had open heart surgery, please refer the Before,
During, and After Your Heart Surgery booklet for activity and exercise
information for you.
Content adapted with permission from Hamilton Health Sciences, New Brunswick
Heart Centre, The Heart Manual, and the Take Heart Program of Vancouver Island.
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Table of Contents
Introduction .............................................................................................................3
Benefits of exercise ..................................................................................................5
General Activity Guidelines ..................................................................................6
Exercise Program for the Early Recovery Period ...............................................9
Warm-up and Cool Down Exercises ..................................................................10
Cardiac Walking Program ...................................................................................13
How much effort should I exert when exercising (walking)? ........................16
Signs to Stop and Rest ..........................................................................................18
Sex ............................................................................................................................19
Travel ......................................................................................................................20
Exercise after the Recovery Period .....................................................................20
Who can Help in My Community? ....................................................................21
Exercise Support ....................................................................................................21
Reducing your risk factors ...................................................................................22
Exercise Log ...........................................................................................................23
Tell us what you think!.........................................................................................29
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Benefits of exercise
Like all muscles, your heart muscle needs exercise. Sitting in a chair or
lounging around does not give your heart the exercise it needs to get and
stay strong.
Being active can help to:
Reduce the risk of more heart Maintain a healthy weight
problems in the future. Improve sleep
Lower blood pressure Make you feel happier
Control diabetes Reduce stress and anxiety
Reduce angina Overcome depression
Lower cholesterol levels Increase resistance to
Reduce symptoms of heart infection
failure
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General Activity Guidelines
2. The goal for the first 6 weeks of recovery is to pace your recovery. All
on your feet activity is work for your heart. Rest and activity
periods should be balanced and spaced throughout the day.
Refer to the Recovery Road booklet to learn what activities you
can do and when to start them. Everyone is different, so talk
with your doctor or cardiac rehab team about what you can and
cannot do at each stage on your recovery.
Slowly increase your activity level each day. This will strengthen
your heart and give it time to heal. Even starting off with a very small
amount of exercise is good.
Avoid sitting for longer than one hour at a time. Get up and walk
around to avoid blood clots in your legs.
Avoid straining or breath-holding (i.e. bowel movements). Use stool
softeners or laxatives if needed to prevent constipation.
If you become too tired or very short of breath with exercise, do not
go to bed for a nap. It is much better for you to rest sitting in a
comfortable chair.
2. Tips for Saving Energy
Allow plenty of time to complete your task; pace yourself and do not
rush. Do not try to do more in a day than your body tells you can.
Alternate heavy and light tasks throughout the day.
Be sure to take rest periods during all your activities.
Avoid extended sleep periods during the day. Short naps are okay.
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3. Stairs and hills
When you first go home, plan your day so that you do not have to
climb stairs if you dont need to.
It requires more energy to climb stairs or hills. Take your
time and rest when you need to.
You should be able to carry on a conversation when going
uphill. Slow down and rest if talking becomes difficult.
Avoid uneven ground and beach walking for 4-6 weeks and until
your balance and endurance improves.IN
Exercising right before a meal may interfere with your appetite. Wait
1-2 hours after a large meal before exercising. It is okay to walk
slowly after eating a snack.
Avoid coffee and alcohol before exercising. The caffeine in coffee is a
stimulant and may affect your exercise ability. Alcohol intake slows
the flow of blood through the heart arteries.
Make sure you keep hydrated. Try to drink fluid every 20
minutes during exercise.
Dress appropriately.
In cold weather exercise during the warmest part of
the day. Wear a scarf around your mouth and nose
to warm the air before it reaches your lungs.
On hot days, exercise during the coolest part of the day.
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During extreme weather conditions (very hot, very cold or very
windy) you may find it easier to walk in a mall or use a stationary
bike with no resistance.
Avoid saunas, extremely hot or cold showers, and hot tubs for the
first few weeks and until your doctor says it is okay.
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Exercise Program for the Early Recovery Period
Your body is in the process of healing for the first 6 weeks. During this time,
exercise is very helpful in improving your general strength and endurance
and preventing the problems from not being active. Plan to exercise at a
time when you feel rested.
Your exercise program for the first 6 weeks will include 2 things:
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Warm-up and Cool Down Exercises
A warm up and cool down routine uses a combination of exercises and
slow walking.
Sit tall on a firm chair with your feet flat on the floor. Try to keep
your shoulders back and relaxed. Avoid slumping forward.
Do these exercises slowly. They should feel comfortable. Do not
force any movements. Breathe normally.
Do 3-5 repetitions of each exercise before starting your walk.
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Shoulder Shrug Shoulder Circles
Hunch shoulders up towards your Rotate shoulders backward and
ears and then relax. then forward.
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Ankle Pumps Knee extension and flexion
Sit in a chair. Lift one leg so your foot is Sit in a chair. Bend your knee and pull
slightly off the floor. Move your foot up your foot under your chair, as far as you
and down and then in circles both ways. can, then bring your foot forward as you
Repeat with other foot. straighten your knee.
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Cardiac Walking Program
Walking will be your main form of exercise during the early
recovery period. It is one of the best exercises for improving
your health. You will have started your program in the
hospital and will continue when you get home.
Determine your pace and degree of exertion using the Talk Test and
RPE Scale (page 16).
Schedule exercise time into your daily routine. Exercising at the same
time every day helps.
Avoid exercising when you are angry or upset.
Wear loose, comfortable clothing and a good pair of
walking shoes. Good foot support is important.
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Walk with someone at first to help you feel more confident. Watch
that you do not compete with anyone including yourself.
Once you are more confident and walking alone, carry a cell phone in
case of emergency. Avoid walking in remote or hard to reach areas.
Take water and your nitroglycerine with you (if prescribed).
For the first 6 weeks, choose walking routes that are on level ground
and are not hilly. Gradually add hilly challenges into your
program as your strength and endurance improves. Be sure to slow
down when you go up hills.
Plan a route where you can rest e.g. on a bench until you have
worked up to a non-stop walk. It is best to walk outdoors or in a mall.
Think of the warm-up and cool-down walks as bookends to your
Cardiac Walking Program. Your heart rate should gradually increase
during the warm-up, stay the same during the Cardiac Walk, and
slow down during the cool-down.
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Begin walking ______minutes 3 times a day. You can add a
few shorter walks if you are feeling up to it.
Increase each Cardiac Walk by 2 minutes per day according
to your Talk Test and RPE Scale.
When your Cardiac Walks are 20 minutes each, reduce the frequency
to 2 times a day, and then gradually increase the time to 30 minutes.
When your Cardiac Walks are 30 minutes each, reduce the frequency
to 1 per day, and then gradually increase the time to 60 minutes.
Keep track of your progress in your Exercise Log (page 23).
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How Much Effort Should I Exert When Exercising (walking)?
There are 2 methods to help determine the effort you should exert when
doing your exercise program. You will use a combination of them to ensure
you are exercising safely.
The RPE Scale rates your exercise effort. The scale scores your total effort,
including the strain and fatigue in your muscles, breathlessness and physical
effort. Pay attention to your overall feeling and not just one factor. Be as
honest as possible and try not to overrate or underrate your perception of
exertion. Aim for RPE of 3-5 (moderate) during your cardiac walk.
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Rate of Perceived Exertion (RPE) Scale
Exercise Effort The Way You Feel Exercise Phase
0 Nothing Able to sing/whistle. Resting
1 Very weak Warm up for 5-10 min &
2 Weak Activity easily performed. Cool down for 5-10 min
Slow to comfortable walk.
3
You can talk easily. This is the desired range
Moderate Feel warmer with some for the first 6 weeks of
4 muscle effort. Breathing will your Cardiac Walk.
be slightly faster and deeper.
Comfortably For some people your
5
strong Brisk to fast walk. Feel exercise may progress to
warmer; feel muscle effort. this level after your
6 Stronger
exercise treadmill test.
7 Vigorous exercise. Difficulty
Very strong
8 talking, breathing hard. Slow down! You have
Very, very
9 Very short of breath. Unable exceeded recommended
strong
to maintain for very long. level of activity!
Maximal
10 All out. Exhausted.
effort
Absolute maximum
NES
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Signs to Stop and Rest
Sometimes you may notice that your exercise effort is higher
than you expect for a specific amount of exercise compared
with previous exercise sessions.
Consider possible reasons and correct them for next time (e.g. change
in weather conditions, a recent heavy meal, busy day, dehydrated,
stressed, coffee/tea, alcohol).
Stop and rest for 2-5 minutes if you have any of these symptoms:
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Strength Activities
Sex
You may have less sex drive in the early recovery period because of
pain, medications, fear or depression. This usually
improves when you feel stronger.
It is normal to feel anxious when you have a normal
sexual response e.g. high heart rate, shortness of
breath and tense muscles.
Talking to your partner about your concerns helps
with closeness. You can create intimacy in other ways besides sexual
intercourse.
About the same amount of energy for sexual intercourse is used when
climbing 20 steps in 10 seconds or walking briskly at 3-4 mph (5-6 km)
per hour. When you can do this comfortably, you generally are able to
have intercourse.
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Avoid sexual activity after a large meal or after exercising. If you feel
tired or tense, wait until you are more rested.
Talk with your doctor or other members of your health care team
about any concerns or questions you or your partner may have about
resuming sexual activity.
Travel
If you are planning to travel, talk to you doctor first! Having good travel
insurance is essential. Most travel insurance companies require that you
have not changed your medications in the last 90 days. Shop around for
travel insurance that is right for you.
Learn more in the Heart & Stroke Foundations Recovery Road booklet
about:
Returning to driving
Travel by air
Returning to sexual activity
Going back to work, and reducing stress
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Who Can Help in My Community?
Exercise support
The time it takes to return to a normal activity level after a heart attack or
procedure will vary greatly, depending on your age, your energy level and
your previous health and fitness levels. A Cardiac Rehab Program can offer
information and support during your recovery.
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Heart Health Education Classes
Learn about the causes of heart disease and ways to optimize your
heart health in the Heart and Stroke Foundations Recovery Road.
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) minutes
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) min.
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) min.
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) min.
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) min.
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Exercise Log
Date Type of Time RPE Scale How I felt
activity (e.g. exercised in 0 to 10 during e.g. cold weather, tired, good
walk) min.
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Tell us what you think!
After reading Activity and Exercise Guide for Heart Patients please
respond to the following statements. Your answers and comments will
help us improve the information.
strongly strongly
Circle one number for each statement: disagree agree
__________________________________________________________________
I read all of the information provided. 1 2 3 4 5
Comments
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The information is easy to read. 1 2 3 4 5
Comments
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The information is easy to understand. 1 2 3 4 5
Comments
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Reading this information will help me 1 2 3 4 5
manage heart failure better.
Comments
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The information answered my questions. 1 2 3 4 5
Comments
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I would recommend this information to 1 2 3 4 5
other patients.
Comments
__________________________________________________________________
I prefer to have this information in:
______ A book just like this one
______Separate handouts on each topic that I need
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I would have liked MORE information about:
__________________________________________________________
__________________________________________________________
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I am:
__ a patient __ a family member
Thank you!
Please give this evaluation form to your health care provider or mail to:
Professional Practice
2nd Floor, Peninsula Health Unit
#206- 2170 Mt. Newton X Rd.
Victoria, BC, V8M 2B2
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