Exercise recommendations for those living with heart disease

Get your doctor's OK before you start to exercise. If you have chest pain or shortness of breath during activity, it might not be safe for you to exercise. Speak with your doctor before taking on an exercise program that would require you to exert yourself.

How much exercise should I do?
    If you are just starting out, you will probably need to start slow. After you have warmed up (very light exercise, such as walking, lasting at least 5 minutes) you can increase your exertion slightly. Your goal is at least 20 minutes of this higher intensity exercise, gradually increasing this minimum to at 30-45 or more of aerobic exercise. Keep your rate of perceived exertion (RPE) to fairly hard to somewhat hard. Your body will take some time to get used to the new movement and increased exertion. Build up to 150 minutes of moderate level (somewhat hard) exercise each week. Those who spend more time engaging in exercise gain more rewards in the way of better weight control and blood pressure, cholesterol, and blood sugar lowering effects.

Walking may be right for you. Simply by walking, you can reap significant health benefits. Walking at the right intensity can provide enough of a stimulus to lower blood pressure, cholesterol levels, and body weight, while increasing bone density that prevents osteoporosis. You will need to supplement with some strength training, because walking does not have much of an effect on building or maintaining muscle mass.

I don't want to do strength training. Because we lose about 6% of our muscle mass with every passing decade (read more here and here), it is vital to engage in strength training to prevent loss of functional capacity and the ability to burn calories. Most aerobic exercises, such as walking, jogging, and moderate cycling, do not provide enough of a stimulus to the muscle to build muscle mass and prevent this age-related loss. You can lift weights, use elastic bands, or even use your own body weight (push ups, crunches, lunges,pull ups) for strength training. Strength training also helps to build a strong and healthy heart.

Blood pressure considerations.
It is helpful to know what your blood pressure is during exercise. Blood pressures that are exaggerated or drop significantly with exercise can mean trouble.You should expect that your systolic blood pressure -- the top number -- will increase between 20-40 beats with significant exercise if you are taking cardiac medication. The diastolic number -- the bottom number -- should not change much, 10 points in either direction is acceptable.
    If you haven't had your blood pressure checked during exercise, it would be prudent to enlist the help of a trained exercise health professional to assess your exercise program and your vital measurements (blood pressure, heart rate, rate of perceived exertion) during exercise. Your physician monitors your blood pressure during a cardiac stress test.

Cardiac medications can change the intensity at which you can exercise. For instance, specific cardiac medications  -- known as beta-blockers -- will keep your heart rate and blood pressure low and, as a result, blunt your heart rate during exertion. If you take a beta-blocker, expect no more than a 20-30 beat increase in your pulse rate during exercise. Commonly prescribed beta-blockers include Toprol, metoprolol, atenolol, Coreg, Lopresor, and sotalol.
    Plainly put, during exercise, your heart rate should be 20-30 beats more than your resting pulse. Read more...

Angina sufferers may need to warm up for longer than 5 minutes. Angina is the discomfort that you feel -- commonly in the chest, neck, back, or jaw -- when your heart is not getting ample blood flow. Arteries that do not dilate well contribute to angina.
    During the warm-up phase of your exercise program, your arteries dilate to accommodate the increased blood flow that will supply working muscles with oxygen and other needed nutrients. For most adults, a 5-minute warm up will suffice. For those with angina, 10-15 minutes of low level exercise may be needed to sufficiently open up the arteries and relieve angina symptoms.