Exercising for a healthy heart
How can I get started on an exercise program?
To get started:
- Have a thorough physical examination before beginning any exercise program. Your doctor may do an electrocardiogram (ECG or EKG), a test that measures the electrical signals that control the rhythm of your heartbeat, and possibly an exercise stress test to assess what level of activity your heart can handle.
- Before your appointment, make a list of questions to discuss with your doctor. For some general questions, see the exercise planning sheet
(What is a PDF document?).
- Make an exercise plan together with your doctor. An exercise program usually consists of stretching, activities that increase your heart rate (aerobic exercise), and strength training (lifting light weights). Visit a library or bookstore for information on exercise programs. Join a health club, walking group, or YMCA. Many cities have senior centres that offer inexpensive exercise programs.
- Learn how to find the right intensity of exercise. To improve your aerobic power, you do not need to submit yourself to strenuous and uncomfortable exercise. In fact, an intensity of exercise called "conversational exercise" (where you can comfortably have a conversation while you are exercising) can be very beneficial.
- Start out slowly. Try parking farther away from the store or walk the mall before shopping. Over time, you will increase your ability to do more.
- Keep a record of your daily exercise. It is okay to skip a day occasionally or to cut back on your exercise if you are too tired or not feeling well.
How can I measure the intensity of my exercise?
Exercise intensity can be measured in many ways, for example as your:
- Rate of perceived exertion (RPE).
- Heart rate (HR).
Your doctor can tell you the correct rate of perceived exertion or how fast your pulse (target heart rate) should be when you exercise.
An easy way to check whether you are exercising enough, but not too much, is to note how hard you are breathing:
- If you can't talk and exercise at the same time, you are exercising too hard.
- If you can talk while you exercise, you are doing fine.
- If you can sing while you exercise, you may not be exercising hard enough.
Calculating your rating of perceived exertion (RPE)
A rating of perceived exertion, or how hard you think your body is working, is a fairly accurate way to tell how much strain is put on your body during exercise. For more information, see monitoring the rate of perceived exertion (RPE).
It is important that you have a clear understanding of the perceived exhaustion levels associated with each number. A training intensity of 13 to 14 (or somewhat hard) would correspond to an exercise HR of approximately 70% HR max. It is important to use both physiological measurement such as HR and psychological monitoring such as RPE to get a clear and more accurate measurement of your overall intensity.
Calculating your heart rate
One of the best ways to measure your exercise intensity is to take your pulse and calculate your beats per minute or heart rate. See taking a pulse
.
Your heart rate gives you a direct measure of how hard your heart is working to deliver blood to your working muscles. You will want to aim for a target heart rate (THR), which is a percentage of how fast your heart is able to beat, known as your estimated maximum heart rate (HR max). Your estimated HR max can be calculated by subtracting your age from 220. For example, a 40-year-old person would have a HR max of 220 – 40 = 180 beats per minute (bpm). This number may vary depending on your medical condition and/or the medications that you are taking, so you should ask your doctor about this calculation.
When you use your heart rate to determine your exercise intensity, your aerobic power will probably improve if you exercise between 60% and 90% of your HR max. You should start lower and gradually increase your THR, and talk to your doctor if you are unsure about how to proceed. The easiest way to calculate your target heart rate is to multiply your HR max by the percentage of how fast you want your heart to beat. For example, if your HR max is 180 bpm and you want to work at 60% of that rate, multiply 180 x 0.60 = 108 bpm. Therefore, your 60% THR is 108 bpm. So if you want your heart to beat 60% as fast as it can, aim for your heart rate to hit 108 bpm while you are exercising.
Your THR may be very different from the actual physiological demands placed on your body. For this reason you may also want to monitor your rating of perceived exertion for a more accurate measure of the strain on your body during exercise.
How often should I exercise?
How often you should exercise depends on several factors. Many exercise programs recommend exercising a minimum of 3 to 5 times a week. Experts recommend exercise on most, preferably all, days of the week.2 However, the best number of days for you may depend upon your time availability, exercise intensity, the duration of each session, and of course, your overall goals. If you exercise at a lower intensity level, you may want to exercise more frequently. Studies have shown that no significant differences in aerobic capacity are found whether these are consecutive or alternate days. If you are trying to lose weight, regular daily exercise is encouraged.
What about duration of exercise?
How long each exercise session lasts depends on the intensity of the exercise as well as your objectives. Of course, the higher your exercise intensity, the lower your exercise duration may be because of fatigue. You should gradually increase the duration of your exercise as your aerobic power increases. You should exercise for long durations if you are trying to lose weight. An hour or even longer may be recommended and very effective.
How important is the mode of activity?
If you hold constant your exercise intensity, frequency, and duration, the mode (type) of activity you do can improve your aerobic power. You will get the most improvement from exercises that use the large muscle groups, such as walking, running, cycling, swimming, or rowing.
Which kind of exercise is best?
As long as you are exercising large muscle groups, choose an activity that you enjoy. For example, gardening and dancing can be excellent forms of aerobic exercise. Enjoying your mode of aerobic exercise will help you stick to your program, which will help you succeed. Achieving your aerobic goals, losing weight, increasing your energy, or developing a positive outlook will increase your enjoyment of the exercise.
Strength training is an important addition to your aerobic exercise program because it strengthens and tones your muscles and increases the blood flow to your working muscles. Many daily activities and activities on the job require moving, lifting, or controlling a weight. Maintaining and improving your muscular strength and endurance will help you perform these activities with less stress on your muscles. Increasing your strength will also increase your metabolism and energy level.
What type of strength-training exercises should I do?
The keys to a safe and effective strength-training program are function and balance. Function means that a muscle exercise should be directly related to its function. For example, the function of your bicep (muscle on the top front of your arm) is to bend your elbow by moving your lower arm towards your shoulder. An exercise to strengthen your bicep should therefore reflect the full range of this motion. Balance is achieved by strengthening complementary muscle groups (muscles that work opposite each other). For example, your bicep flexes your arm while your tricep (muscle on the top back of your arm) extends your arm; while your bicep contracts, your tricep lengthens.
A good program should also focus on the major muscle groups of your body, especially the muscle groups used in your daily life. Strength-training exercises are described in hundreds of magazines and fitness books and on television shows and Web sites.
If you are a beginner, choose exercises that contain simple motions, emphasize spinal stability, and focus on specific groups of muscles. Most advertised exercises are beneficial and safe if you maintain control of the weight and use the proper technique throughout the exercise. Holding your breath while lifting puts extra strain on your heart, so always exhale when lifting any weight.
Working out with a partner is recommended to keep you safe during your strength training. A partner can make sure that you are lifting the appropriate amount of weight for each exercise and check your form and technique.
What is resistance?
In strength training, resistance is the force that you are pulling against to work your muscles. A common type of resistance is weight. At your gym or fitness centre, there are probably many different types of dumbbells and weight machines for you to use. However, resistance for increasing muscle strength and endurance can come from other things besides weights and weight machines.
Your own body weight, elastic bands, and wall pulleys can provide effective and progressive strength training. Begin with a weight that you can easily carry through the required range of motion. You should only increase the resistance [gradually, or by 2 kg (5 lb) to 4.5 kg (10 lb)] when you can comfortably do the exercises and weights that you've been using for a few weeks.
If you have angina, heart failure, or other heart conditions, you may increase the number of times you perform each exercise, but keep the resistance the same. Your movement should be slow and controlled at all times. If you feel that you cannot control the resistance, decrease the resistance or lower the weight. Avoid straining, and stop exercising if you feel symptoms such as dizziness, unusual shortness of breath, or any form of pain.
What are repetitions and sets?
Repetitions are the number of times you perform each exercise. For example, if you lift a dumbbell up and down once, that's 1 repetition (or rep). If you lift it 5 times, that's 5 reps. Sets are the number of times you do a certain number of repetitions. For example, if you lift the dumbbell 15 times, take a rest, and then lift it another 15 times, you have done two sets of 15 reps each.
The number of repetitions and sets you do depends on your strength-training goals. If you wanted big bulky muscles, you would do a few sets of a few reps with very heavy weights. However, you may want muscular tone and endurance, which means a few sets of many repetitions with light or medium weights. A good place to start is with one set of 12 repetitions. You can gradually work up to 2 or 3 sets of 12 to 15 repetitions.
How can I stretch for flexibility?
Everyone can benefit from stretching exercises, regardless of age or flexibility. It is important for you to make stretching a part of your daily exercise routine. Stretching to increase flexibility should focus on the large muscle groups, and especially muscle groups that affect your posture and mobility.
Before beginning to stretch, warm up your muscles by walking or another gentle movement for a few minutes. You may injure your muscle or tendon if the muscle is cold and has not been used in a while. You should always stretch in a slow and controlled manner. Each stretching exercise should be repeated 3 to 5 times and held for 10 to 30 seconds each time. You should try to gradually increase your range of motion during each repeated exercise. A feeling of tension is normal, but do not hold a stretch that is painful.
General guidelines for stretching exercises
- Stretch before and after exercising.
- Stretch to a position of mild discomfort for 10 to 30 seconds for each stretch. Try each stretch 3 to 5 times.
- Control and hold without resistance
- Emphasis on lower back and legs
How can I include exercise in my daily routine?
Remember that even a little exercise is better than none at all. Here are some tips on building exercise into your daily routine:
- Get up 15 minutes early and stretch.
- Jog in place.
- Take a walk at lunchtime or after dinner. Use the stairs instead of the elevator.
- Walk to a co-worker's office instead of calling or e-mailing.
- Get off the bus one or two stops early and walk the rest of the way.
- Wash and wax your car by hand instead of driving through the car wash.
- When you go shopping, park farther away from the store.
- Take a brisk walk around the mall before you start shopping.
- Lift light arm weights while talking on the phone.
- Ride a bike.
- Wash the windows. Work in your garden or yard. Use a push mower instead of a riding mower.
- Walk the dog.
- Work out to an exercise video.
- Go dancing.
- Try to be active as a family, like playing tag or catch, and taking active vacations.
How can I stick to my exercise program?
Sticking to a regular exercise schedule requires discipline and motivation. At times, it may seem difficult to keep up with regular exercise and physical activity. However, persistence pays off. There are specific steps you can take to make your exercise program more effective and also to help you stick with it:
- Try to make your exercise fun. Do activities you enjoy.
- Set realistic goals. If you expect too much, you are likely to become discouraged and stop exercising.
- Give yourself time. It can take months to get into the habit of exercising. After a few months, you may find that you are looking forward to it.
- Stay with it. It can be hard to stick with an exercise plan. Try exercising with a friend—it is much easier to continue an exercise program if you are exercising with someone else.
- Reward yourself. Build in rewards along the way that help you continue your program.
What measures should I take to stay healthy while exercising?
When starting an exercise program, keep the following precautions in mind:
- Pace yourself by alternating exercises. Rotate light workouts, such as short walks, with more strenuous exercises, such as low-impact aerobics or swimming.
- Avoid exercising outdoors in extreme temperatures or high humidity or poor air quality. When the weather is bad, try exercising indoors at a gym or walking at a mall.
- Avoid exercises that require or encourage holding your breath, such as push-ups, sit-ups, and isometric exercises. Also avoid heavy lifting.
- If you develop palpitations, chest pain, difficulty breathing, or dizziness or light-headedness, stop exercising and rest. Call your doctor if these symptoms don't go away.
- Do not take hot or cold showers or sauna baths after exercising. Moderate temperatures are best—very hot or very cold temperatures can be dangerous.
- Ask your doctor about continuing your exercise program if your medications change. New medications can affect your how you feel when you exercise.
- Do not take naps or lie down after exercise because that reduces exercise tolerance. Instead, sit down to rest.
- Take your pulse frequently or wear a heart rate monitor and keep your pulse within the parameters your doctor sets. Watch your pulse when walking up hills or stairs.
- Make sure you adjust your exercise program if it is interrupted for more than just a couple of days. Gradually increase to your regular activity level as tolerated.
Test Your Knowledge
An exercise program usually consists of stretching, activities that increase your heart rate (aerobic exercise), and strength training (lifting light weights).
Do not take naps or lie down after exercise.
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: September 21, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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