We know that exercise is good for our hearts and overall health. But is that true for people living with heart failure? And if it is, how should they start exercising?
The good news is that exercise is safe for heart failure patients even at fairly high risk, and it has health benefits. But there are some guidelines they should follow to stay safe and get the best results.
Here's some advice if you have heart failure, also called congestive heart failure, and want to add exercise to your routine.
Can you exercise with heart failure?
Many people who have heart failure ask if it’s helpful — or even safe — to exercise. The short answer is yes.
Not only is it safe to exercise under medical supervision, but it has health benefits for patients with heart failure.
A study showed that patients with heart failure who exercised had reduced hospitalizations and readmissions and improved quality of life. Those who exercised under medical supervision had greater improvement.
The group that was more supervised had a decrease in hospitalization and no increase in adverse cardiovascular events or defibrillator shocks.
The study also showed that exercise was safe even for patients at high risk — those with ischemic cardiomyopathy with ejection fractions of 25% and less, meaning their heart pumping function is less than half of what it should be.
Because of those results, moderate exercise is now a common part of recommended treatment for heart failure patients called guideline-directed medical therapy.
But exercise is only one important part of heart failure therapy. It must be combined with other forms of care for the best results.
Patients with heart failure also need to make sure they don’t put too much stress on their hearts. They have to start slower because their hearts have already been challenged.
Ideally, patients should get a minimum of 150 minutes of moderate exercise or movement per week. Your cardiologist or physical therapist can help you find a safe heart rate and limits on how much you exert yourself.
What are the best exercises for heart failure?
There are many exercises that are appropriate for people with heart failure, but the best exercise for you will be based on your health and ability.
Exercises that may work best for heart failure patients include the following:
- Brisk walking, preferably with a walking stick
- Light jogging once you’ve reconditioned yourself with walking
- Cycling on easy, level terrain
- Swimming
- Water aerobics
- Traditional Chinese exercises that focus on mindful breathing, like Tai Chi, Baduanjin, Liuzijue and Wuqinxi
- Chair exercises with or without weights, especially for less mobile patients or those who can’t stand
But before you try more strenuous activities, you will need to build up your strength and health. You can also modify certain exercises to better suit your needs. For example, running may not be safe for you right away.
If you were a runner and want to start again, start with walking. You'll need to recondition your body. So try briskly walking over terrain with some hills and moving your arms.
You may want to use a walking stick. This can help you gain stability if you feel dizzy or lightheaded, and you’ll get the benefit of moving your arms as you walk. Once you’ve reconditioned yourself, you may move on to jogging if your cardiologist recommends it.
If you enjoy cycling, you should also start slowly. You may need to avoid mountain biking because it puts more stress on your heart. Try cycling that doesn't have heavy changes in terrain.
Swimming and water aerobics are often easier on the hips and joints. Swimming can help with conditioning your breathing as you hold your breath, and the resistance of the water conditions your strength.
Some water aerobic exercises you can try include using a kickboard and kicking to get your legs moving or putting a buoy between your legs while moving your arms.
Traditional Chinese exercises, like Tai Chi, Baduanjin, Liuzijue and Wuqinxi, are becoming more mainstream in the U.S. and can benefit people with heart failure, too.
These exercises incorporate mindfulness, meditation and analysis of breathing. The slow, rhythmic movements, like with Tai Chi, still get you moving and will raise your heart rate without high impact. A lot of these exercises also work your core and improve stability.
And if you have trouble with mobility or can’t for long, try some chair exercises. These are movements you can do while sitting in a chair, like knee raises and arm lifts.
You can still get your heart rate up anytime you're moving your arms above your head. If you have hand weights, you’re also working on strength while demanding more of your heart.
Can exercise be dangerous or make heart failure worse?
While exercise, especially under medical supervision, has health benefits for people with heart failure, it has to be done safely. Some exercises are dangerous and can make heart failure worse.
Heart failure patients should avoid the following:
- Exercise in extreme temperatures, including cross-country skiing
- Exercises that are too strenuous when starting out, including running, dancing and mountain biking
- Exercise without consulting your cardiac health provider or physical therapist
If you live in a place with an extreme climate or severe seasonal changes in temperature, like much of the Midwest, exercising outdoors can be dangerous.
Extreme weather, when it’s really hot or cold, can be hard for your body to acclimate to, aside from what you require to exercise.
When people exercise in the cold, they tend to bundle up with coats and gear. That extra covering could add extra weight and cause sweating, which can impact the heart and body. There’s also a risk of injury from slipping on ice or even frostbite.
If you need to exercise outdoors when it’s hot, try heading out in the early morning or after sunset when it’s cooler. In very cold temperatures, limit your time outside to no more than 30 minutes.
Consulting with a cardiac care provider is essential for heart failure patients before they start exercising.
First, they can monitor your vitals to make sure you stay in the right aerobic zone — that’s where you get the best oxygenation to your muscles. If you start to exercise too strenuously, you can get past your anaerobic threshold, and that’s when you’re pushing your heart too hard.
At that point, you’re going into more of a lactic acid state. That’s not safe, and it’s more for athletes. It can put heart failure patients in a dangerous position of possibly falling or injuring themselves.
Your care provider can also monitor your Borg rating, which is a rating of your perceived exertion. It’s on a scale of 1 to 10 and measures how hard you’re pushing yourself.
When you’re at rest, your Borg rating is likely a 1. When you start to exercise, you should be at a 2 to 3. That’s when your heart rate is somewhat elevated, and your muscles are warming up. You’re not breaking a sweat, and you can still have a conversation.
Depending on your symptoms and how well your reconditioning is going, your provider may suggest increasing your Borg rating during exercise.
As you get into your aerobic zone, your Borg rating will be at a 5 to 7. You’ll break a sweat, and your muscles will be warmed up. You won’t have any chest pains or palpitations. You may be a bit more breathless, but you’ll still be able to hold a conversation.
By learning about your heart rate and Borg score, you’ll be able to monitor yourself whenever you exercise without direct supervision.
Can heart failure be reversed with exercise?
While exercise will not necessarily reverse heart failure on its own, it has helped many patients improve their heart health when combined with other therapies.
Some patients can even get to a point where there is very little difference between before they had heart failure and after they’ve progressed with cardiac rehabilitation.
Studies have demonstrated that with regular exercise, the pumping function of the heart for patients who have reduced pumping function can improve. For other heart failure patients, it can also improve relaxation for stiffer, less compliant ventricles.
With cardiac rehabilitation, your care provider won’t just try to preserve your current heart health or slow the progression of your disease. They will work to improve your condition, not just sustain you.
How does exercise improve quality of life for heart failure patients?
Many heart failure patients see exercise-related improvements in their quality of life, as well as their heart health.
For example, heart failure patients often lose a lot of skeletal muscle and become more frail. With strength exercises, they can build that skeletal muscle back.
This improves their strength, balance and ability to be mobile safely, preventing falls and injuries. The improvements in cardiovascular and physical health mean fewer ER visits and hospitalizations.
With exercise, mental and emotional well-being often improve for patients, as well. All of these benefits combined with other therapies can not only improve life — but extend it.
Studies demonstrate that exercise improves cardiac mortality and morbidity, even in elderly patients who’ve had heart failure for quite a while. And that's true for the entire spectrum of cardiovascular diseases, not just heart failure.
If you’re living with heart failure and need care, including cardiac rehabilitation that will help you exercise safely and improve your health, call Rush at (888) 352-7874 or learn more on our Heart Failure Treatment page.
