What if I have ANGINA?
The exercise programme that is recommended for stable angina patients is common to all coronary heart disease patients ( stable angina, angioplasty, stent, MI and CABG patients ) and is described above on these web pages.
It is highly recommended that you have a graded exercise ECG test in order to discover what is your angina threshold. In other words at what heart rate you begin to get your exertional angina or ECG ST segment depression changes of greater than 1 mm from that of your resting traces.
You should not do straining, breath-holding, isometric-type exercises such as press-ups and highly competitive, intermittent, explosive type sports such as squash or racket ball may be dangerous.
Warm-ups and cool-downs need to be prolonged at 10 to 15 minutes each and avoid very cold or windy weather and exercising too soon after a meal.
In your training use the ‘ Angina Rating Scale ‘ and stop exercising when you reach an angina rating of 2 ( CP++ ). If your chest pain / tightness / discomfort … does not go away within 5 minutes of resting, sit down and take your nitrate tablet or spray as you have been instructed. If the angina still does not go away after a further 5 to 10 minutes and has lasted a total of 15 minutes, telephone your emergency number immediately without delay and ask for a paramedic ambulance to take you to the nearest hospital emergency room for tests.
If you experience any change in your symptoms or worsening of your angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading. [2:49][5:49,57,183][6:44]
What if I have had an ANGIOPLASTY?
The exercise programme that is recommended for angioplasty patients is common to all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ) so please refer to the recommendations for Angina patients above.
It is adviseable to complete a supervised hospital-based cardiac rehabilitation programme before commencing training on your own.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises.
As the risk of re-blockage is greatest in the first 6 months after the procedure you are advised to wait this time before doing any vigorous or resistance type exercises and only do this type of exercise if your doctor / physician says you can.
If you experience any recurrence of symptoms or increased angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading.[3:230][5:146]
What if I have had a STENT?
The exercise programme that is recommended for stent patients is common to all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ) so please refer to the recommendations for Angina patients above.
It is adviseable to complete a supervised hospital-based cardiac rehabilitation programme before commencing training on your own.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises.
As the risk of re-blockage and the risk of dislodgement of the stent by MRI scanner is greatest in the first 6 months after the procedure you are advised to wait this time before doing any vigorous or resistance type exercises and only do this type of exercise if your doctor / physician says you can.
If you experience any recurrence of symptoms or increased angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading.[3:230][5:146]
What if I have had a BYPASS?
The exercise programme that is recommended for bypass graft patients is common to all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ) so please refer to the recommendations for Angina patients above.
Ideally you should have a post-operative exercise ECG test prior to starting a supervised hospital-based cardiac rehabilitation programme six to seven weeks after the surgery and to complete this before commencing training on your own.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises.
The breast bone that was opened for the operation may take many months to heal. So you may feel muscular pain, especially in the centre of your chest, neck, back and arms. For this reason heavy lifting should be avoided for at least three months following the operation.
If a vein was removed from your leg for the bypass graft, you may feel discomfort or numbness in this leg and have some ankle swelling. Keep your doctor / physician informed of this.
If you experience any worsening of symptoms such as fever, fatigue, breathlessness or increased angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading.[3:232][5:108,146]
What if I have had a HEART ATTACK?
The exercise programme that is recommended for heart attack patients is common to all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ) so please refer to the recommendations for Angina patients above.
Ideally you should have a post-MI ( Myocardial Infarction ) exercise ECG test prior to starting a supervised hospital-based cardiac rehabilitation programme six weeks after the heart attack and to complete this before commencing training on your own.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises.
Depending on where the heart attack was and how big it was will determine how quickly your heart recovers its pumping ability. The spontaneous natural healing process is quite rapid over the first twelve weeks so exercise improvements will be the most dramatic over this period of time.
As a heart attack patient it is adviseable to occasionally record your exercising, peak and recovery blood pressure readings along side your pulse rate.
If you experience any worsening of symptoms such as fever, fatigue, breathlessness or increased angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading.[5:54]
What if I have HEART FAILURE?
Before using any of the following information it is strongly advised that you discuss it first with your doctor / physician and specialist nurse at your next follow-up appointment.
The following evidence-based recommendations are for stable chronic heart failure patients with New York Heart Association Functional Classification ( NYHA ) One, Two and Three but NOT Four.
Recent research has shown heart failure patients can benefit greatly from an exercise programme that consists of aerobic / steady state, interval and resistance exercise sessions.
The aerobic exercise session is the same as that described on the web pages above for all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ). If you are not quite at the beginner level ( more compromised patients ) then short multiple daily sessions of 5 to 10 minutes may be necessary until fitness improves. Your eventual goal should be to perform continuous aerobic exercise for a maximum of 30 minutes.
Interval training using a stationary cycle should consist of work phases of 30 seconds at an intensity of 50% of maximal effort and recovery phases of 60 seconds. Maximal effort can be determined by first pedalling for 3 minutes without any resistance and then increasing the work rate by 25 Watts every 10 seconds until it is impossible to pedal without straining. When this happens stop. Now multiply this maximal wattage by 0.5 to calculate 50% which you will use for your interval training. During the recovery phase you should pedal at 10 Watts. On a treadmill work and recovery phases of 60 seconds each may be used.
Again, the recommended resistance training programme is the one described on the web pages above. If you have been cleared to do this programme by your medical practitioner you must avoid the valsalva manoeuvre and isometric exercises at all costs.
If you experience any worsening of symptoms such as fever, fatigue, breathlessness or angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this sub-heading.[5:163][9][10][12][13]
What if I have had a HEART TRANSPLANT?
Before using any of the following information it is strongly advised that you discuss it first with your doctor / physician and specialist nurse at your next follow-up appointment.
It is highly recommended that a medically supervised graded ECG stress test be performed with oxygen consumption measurements taken before starting on the exercise training programmes described below.
The heart transplant patient can do a combined Aerobic and Resistance training programme. Both of these programmes are described on the web pages above.
As the transplanted heart has no vagus ( sympathetic and parasympathetic ) nerve supply it is very important to do a very gradual warm-up because it usually takes 6 to 10 minutes for the transplanted heart to reach a stable rate for any particular workload ( approximately 2 to 3 times slower than a non-transplant heart ). That is up to 30 to 50% of maximum capacity ( HRR ). Once you get above this intensity the transplanted heart will increase rapidly in rate. Therefore start with gentle stretching of the muscles to be used in the coming exercise, then other gentle warm-up exercises. This releases hormones into the circulation, which in turn tells the heart to speed up and pump harder. After this 10 minutes warm-up you can go into your endurance ( aerobic ) training. Corticoid therapy also puts you at slightly higher risk of tendonitis or muscle rupture therefore you have another good reason to do a slow, gradual warm-up.
Intensity for continuous moderate effort should be set at 60% of maximal capacity or HRR determined by exercise ECG test or alternate periods of high workload ( 70% max. ) and low workload ( 50% max. ) for interval training. The resting heart rate of a transplanted heart will be higher than that of a non-transplanted heart and so this must be considered when calculating Training Heart Rate Ranges.
The initial goal is to do at least 30 minutes and build up gradually to a session lasting 45 to 60 minutes. This should be repeated at least 3 times per week.
It always takes far longer for the heart transplant patient to return to a resting heart rate. The heart rate will sometimes remain high for one or two minutes after stopping exercise before it begins to drop to its resting rate. Therefore you need a relatively long active recovery period at 30 to 40% of maximum capacity or HRR.
Due to the high risk of infection to you, wait 5 to 6 months after the operation before resuming swimming and wait 3 months after you have received treatment for any rejection episode before resuming swimming. NEVER attempt to exercise / train during episodes of organ rejection.
When doing resistance training do not hold your breath while lifting the weight and do not strain. Learn the stop signs and symptoms on these web pages.
Both types of exercise training programmes help prevent problems associated with the taking of immunosuppressant drugs, limits the atrophy of muscle due to corticosteroids, slows the loss of bone density ( a side effect of prednisone, one of the drugs taken to prevent organ rejection ) and reduces arterial hypertension as a side-effect of taking cyclosporin.
Exercise training will reduce the resting heart rate of the transplanted heart and increase its aerobic capacity thereby improving fitness for day-to-day activities.
If you experience any worsening of symptoms such as fever, fatigue, breathlessness or angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this sub-heading.[3:49][11][14]
What if I have a PACEMAKER?
Post Implant:
Hopefully your pacemaker has been sited near to your non-dominant and least used arm. Do not worry if this is not so. The doctor probably had a good reason for not doing this.
You must limit weight-bearing arm movements on the side you had the pacemaker implanted so that the pacemaker wires have a good chance to become well embedded into the heart muscle.
The pacemaker implant site may take a few weeks to completely heal and for the bruising to go away. While there is bruising you may feel some muscular pain in your chest or shoulder. For this reason you might like to avoid heavy lifting until this has completely gone.
Follow-up:
Keep on you at all times your Pacemaker Identification Card which you should have been given soon after the pacemaker was implanted.
If you do not yet have one of these ask if you can have it. If you have not received your next follow-up pacemaker check appointment do not assume it will eventually come in the post. Telephone the hospital department that does the checks and ask them to confirm your next pacemaker check appointment date and time and write this on your calender or in your diary. It is very important to turn up for these pacemaker checks. As a cardiac athlete who indulges in frequent episodes of high-rate pacing, you may need to have slightly more frequent follow-up checks in order to more closely monitor battery depletion. If you can not make your appointment for some reason or other please notify the hospital as soon as you can so that your appointment slot can be offered to someone else who needs it. Be sure to ask for a new appointment for yourself.
If you experience any worsening of symptoms report it immediately to your doctor / physician without delay and get it checked out. You should report any dizziness, increase in breathlessness or fatigue, persistent chest muscle twitch or hiccups, bruising, redness, swelling, increase in palpitations, a pulse below the lower pacing rate, itching, tenderness, inflammation, or discharge around the pacemaker wound site or any of the symptoms you experienced before you had the pacemaker inserted and of course any angina.
Pre Exercise:
Ideally you should have a post-operative exercise ECG test prior to starting a supervised hospital-based cardiac rehabilitation programme six to seven weeks after the procedure and to complete this before commencing training on your own.
Type of Exercise:
A suitable exercise training programme depends very much on your underlying heart conduction abnormality, what type of pacemaker system was implanted and your other cardiac history.
The exercise programme that is generally recommended for pacemaker patients is similar to that of all ischaemic cardiac conditions ( stable angina, angioplasty, stent, MI and CABG patients ) so please refer to the recommendations for Angina patients above.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises and build up your fitness and stamina.
Eventually you should be able to do most activities and sports but not ‘contact sports’ as they could potentially damage your pacemaker.
Care must be taken with activities / exercises that involve excessive Range of Movement ( ROM ) in the shoulders as this increases the likelihood of crushing the pacemaker wire between the first rib and collar bone. This is sometimes refered to as a ‘clavicular pinch’. A few examples of excessive shoulder motion can be seen in certain yoga postures, seated overhead presses, swimming butterfly and two-handed racket or golf swings.
Self-Regulation:
You can calculate safe and effective exercise training heart rates by use of the standard Karvonen equation explained on the web pages above. The maximal training heart rate of 80% of HRR ( or 85% of MHR ) can be programmed into the pacemaker as the maximal pacing rate.
As a cardiac athlete with a pacemaker it is adviseable to occasionally record your exercising, peak exercise and recovery blood pressures alongside your pulse rates.
Rate Responsiveness:
Some pacemakers have activity sensors which detect body activity and adjust the pacing rate accordingly. Some of these pacemakers are ‘semi-automatic’ and self-adjusting. Others need to be fine-tuned by the doctor or technician at your pacemaker follow-up checks.
There are many pacemaker parameters which are useful to the cardiac athlete and these can all be adjusted. The ADL ( Activities of Daily Living ) rate should be programmed to provide adequate cardiac output during your typical daily activity. The Activity Acceleration slope determines how quickly you get up to your exercise training heart rate. A Rate-Adaptive AV feature mimics normal physiological responses to vigorous exercise. The Upper Sensor Rate and Upper Tracking Rate should be programmed to provide a cardiac output that meets your metabolic demand during exercise without provoking symptoms such as angina, etc. The Activity Deceleration slope determines your recovery rate after exercise.
Diagnostics:
In order to monitor how successful any programming changes are the appropriate diagnostic functions should be set to ‘on’. This is like having your very own internal 24 hour ECG recorder and will help to fine-tune the pacemaker to you and your sporting lifestyle.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading. [3:232][5:108,146]
What if I have a HEART VALVE?
The exercise programme that is recommended for heart valve patients is similar to that of CABG surgery patients and other ischaemic cardiac conditions ( stable angina, angioplasty, stent and MI patients ) so please refer to the recommendations for Angina patients above.
Ideally you should have a post-operative exercise ECG test prior to starting a supervised hospital-based cardiac rehabilitation programme six to seven weeks after the surgery and to complete this before commencing training on your own.
Initially you should just concentrate on doing low to moderate intensity and duration aerobic type exercises.
The breast bone that was opened for the operation may take many months to heal. So you may feel muscular pain, especially in the centre of your chest, neck, back and arms. For this reason heavy lifting should be avoided for at least three months following the operation.
It is recommended that you keep with you at all times a card that has on it details as to the exact make and model of heart valve that you have, the manufacturers name, the valve size and position and when it was put in. This will help the doctor or technician to monitor your heart valves success between the yearly echocardiograms you should be having. It will also be very useful information if ever you are taken to hospital.
As you are a cardiac athlete and you are used to keeping details of your exercise training you might also like to keep a record of some of your echocardiogram results such as your left ventricular ejection fraction, stroke volume, left ventricular mass and flow velocities across the valve but this would need to be negotiated with your doctor / physician.
If you experience any worsening of symptoms such as fever, fatigue, breathlessness or increased angina go back to your doctor / physician without delay and get it checked out.
As more condition-specific tips are received from cardiac athletes and recommendations published in the scientific literature they will be posted under this subheading. [5:108,147]
References
[1] Leakey RE. The Making of Mankind. Abacus Books 1981.
[2] Blair SN, Gibbons LW, Painter P et al. American College of Sports Medicine: Guidelines for Exercise Testing and Prescription. Third Edition. Lea and Febiger 1986.
[3] Blair SN, Painter P, Pate RR, Smith LK, Taylor CB. American College of Sports Medicine: Resource Manual for Guidelines for Exercise Testing and Prescription. Lea and Febiger 1988.
[4] Howley ET, Franks BD. Health / Fitness Instructor’s Handbook. Human Kinetics Publishers Inc. 1986.
[5] Bethell H. Exercise-Based Cardiac Rehabilitation. Publishing Initiatives Books 1996.
[6] Cleland JGF, Findlay IN, Gilligan D, Pennell DJ. The Essentials of Exercise Electrocardiography. Current Medical Literature Ltd. 1993.
[7] Borg G. Perceived exertion as an indicator of somatic stress. Scand J of Rehab Med 1970; 2: 92-98.
[8] Borg GAV. Psychophysical bases of perceived exertion. Med Sci Spor Exerc 1982; 14(5): 377-381.
[9] Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life and clinical outcome. Circulation 1999 Mar 9; 99: 1173-82.
[10]Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001; 22: 1539-1540.
[11]Kobashigawa JA, Leaf DA, Lee N et al. A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 1999 Jan 28; 340: 272-7.
[12]http://www.unmc.edu/PhysicalTherapy/chf.htm
[13]http://www.acponline.org/journals/ebm/sepoct99/belard.htm
[14]http://www.multimania.com/angc/english/vademecum_en/12physiotherapy.html
