Exercising with a diagnosis: how hard is too hard?

The question has changed

For most of the last century the advice after a cardiac event was rest. It is not any more, and the change is one of the better-supported reversals in medicine: structured exercise after most cardiac diagnoses improves symptoms, function and outcomes.

So the question people arrive with — am I allowed to exercise — usually has a short answer. The useful question is the second one: how hard, and how would I know.

Two ways to answer “how hard”

The talk test is the crude version and works surprisingly well. At the right intensity you can hold a conversation but not sing. If you cannot speak a full sentence you are above the range that most rehabilitation programmes aim for.

Perceived exertion is the version we use in clinic. On a scale of six to twenty, most cardiac rehabilitation sits between eleven and fourteen — “light” to “somewhat hard”. If you have been given a specific heart rate range after a stress test, that range beats both of these, because it was measured on you.

The symptoms that mean stop

Chest pain, tightness or pressure. Breathlessness far beyond what the effort would explain. Dizziness or feeling like you might faint. A racing or irregular heartbeat that is new. Unusual fatigue that arrives suddenly rather than building.

Any of those means stop, sit down, and recover. If it does not settle within a few minutes of rest, or it came with chest pain, that is an emergency call rather than something to mention next month.

Building up

Most people do too much in week one and nothing in week three. The pattern that works is dull: start below what you think you can manage, add about ten per cent a week, and keep the increases in one dimension at a time — longer, or harder, not both.

Warm up for five minutes and cool down for five. After a cardiac event the cool-down is not optional; stopping abruptly is when rhythm problems are most likely.

Where cardiac rehabilitation fits

If you have been offered a rehabilitation programme, take it. Supervised exercise with monitoring is the fastest way to find out what your actual limits are rather than guessing at them, and people who complete a programme do better than people who do the same exercise alone.

We run sessions at Pearl District and Lloyd Center, and a dietitian sits in on every course.

Before you start anything new

Bring it to your next appointment, especially if you are on a medication that blunts heart rate — beta blockers make heart-rate targets meaningless and the talk test the better guide. If you have symptoms at rest, or symptoms that have changed recently, that conversation should come before the first session rather than after it.