Exercise for the Heart Patient, for Postop Patients, and for the Hospitalized - After the heart attack

Through regular exercise the heart attack victim earns a second chance in life. But he faces a difficult challenge. He has to devote constant effort to his exercise regimen. If he backslides, or drops out of the program, he usually finds that deterioration sets in within days or weeks.

The training program that the heart attack victim undertakes should be geared to his personal physical situation. He should start it only with the approval of his physician, and should progress at the prescribed rate. In most cases the post-heart attack exerciser will be asked to keep track of his rate of progression. In all cases he will be asked to see his physician at prescribed intervals.

Postcoronary exercise has, like all exercise, specific goals. It can be very effective in increasing cardiac efficiency by decreasing the heart rate and the consumption of oxygen at a given workload. The training, taken initially in small doses, makes it possible for the muscles to extract more oxygen from the blood. The heart can then pump less blood for a given task. In time, the heart becomes less susceptible to the ill effects of stress hormones, or catecholamines, that circulate in the blood. The patient usually learns to respond better to stress-filled situations. He can control his weight more easily.

With improved physical condition may come other benefits. The patient may experience little or none of the depression that is so common following a heart attack. Chest pains may dwindle or disappear entirely. Many patients experience relief from angina—a cramp-like chest pain—as their fitness levels improve.

Problems and Preparations

The postcoronary exercise regimen calls for advance consideration of a number of problems. A practical problem is that the patient may find that the program cuts into his work, family, and social life. If he lives in a large city, he may have difficulty commuting to and from the clinic, YMCA, or other institution offering the program.

In consultation with his physician, the patient can in most cases develop an exercise program that eliminates many such problems. In so doing, he increases the likelihood that he can continue to exercise consistently. Typically, he reduces the number of medically supervised sessions to a minimal weekly number compatible with training effectiveness and safety. The “minimal number” may be once or twice weekly. Some physicians give their patients specific instructions and then trust the individual to continue on his own.

Authorities believe that a heart attack victim's assumption of responsibility for all or part of his own fitness program teaches the patient to cope with the stresses, strains, and difficulties that he inevitably faces as he moves toward complete rehabilitation. Also, he grows accustomed to normal living more quickly. In a sense, he becomes by degrees independent of physician, clinic, or other medical advisor without neglecting basic precautions or the prescribed periodic checkups.

A stress test should precede the start of the fitness program. The patient can determine his own sustained maximum heart rate by subtracting his age from the figure 220. Thus a man of 40 would have a maximum sustained rate of 180.

In later stress retesting, usually carried out at four to eight week intervals, the patient may be asked to exercise until his heart rate approaches the maximum. Initially, in each of the four to six exercise sessions each week, he works his heart for half an hour at a rate equal to about 70 or 75 percent of the maximum. The man of 40, mentioned earlier, is thus able to bring his exercising heart rate to about 126.

In a second phase, again undertaken with his physician's approval, the patient may be allowed to bring his exercising heart rate as high as 85 per cent of the maximum. A third and even a fourth phase might follow if necessary.

The stress test may be administered with a bicycle ergometer or a treadmill. During the test, the electrocardiogram is monitored continuously. Breath analyses may be taken as a means of estimating the patient's actual maximum oxygen consumption. Afterward, depending on the program, the patient may be placed in a “complicated” or “uncomplicated” category. In the uncomplicated group are those who have worked their hearts to 70 to 75 percent of the maximum heart rate without developing abnormalities in the electrocardiogram. In the complicated group are those who cannot finish the tests because evidence of cardiac ischemia, or lack of oxygen for the heart muscle, has appeared.

As a final preparatory step, the patient may receive a personal exercise prescription. After later stress tests, he learns, he will receive new prescriptions as he progresses. He may, if needed, receive instructions in the methods of taking a pulse count.

Exercises of Choice

Recommended exercises of postcoronary patients include walking, jogging, swimming, and others. But the exercises cannot be taken randomly. The patient should walk or jog a specific distance, or swim a specified number of laps, while timing himself with a stopwatch. He will probably be told that he cannot use a regular watch in timing his sessions because such a method of measurement lacks accuracy.

A typical clinic session for a postcoronary group might start with a talk or discussion. Patients learn that they can discuss problems relating to their physical situation or their home exercise prescriptions. They also find out about the “do's” and “don't's” that apply to them, about medications and their uses, and about the meanings of various cardiac signs. Sexual problems may come up for discussion; so may fad diets and the values of “cures” for heart disease that have been reported in the media.

The beginner's session may continue with a 10- to 20-minute warm-up. While music provides a rhythmic accompaniment, the patient may go through simple flexibility exercises interspersed with light walking and jogging. In a class session, the group may halt all activity at specified intervals to take a pulse count. If any individual indicates that he is having chest pains or other problems, he may be asked to stop and undergo a further medical assessment, including electrocardiograms. Instruction for all participants will usually cover proper jogging techniques. Following the warm-up, participants go into their prescribed exercise series. They conclude with a cool-down period lasting 10 to 15 minutes.

As postcoronary exercise sessions continue, the patient may be asked to keep a detailed log. Entries cover current prescriptions, the time and distance data on each workout, and pre- and postworkout heart rates. Periodically—usually once a month— the patient takes his resting heart rate, preferably before he gets out of bed in the morning. He may be asked to ascertain the average of three consecutive morning heart counts. In all cases, the distance, speeds, and heart rates are carefully charted for each patient.

Using such information, a physician can easily gauge a patient's progress. In most cases a patient will show improvement within weeks. But doctors believe that an exercise regimen should be continued for at least a year if substantial benefits are to be achieved. Two years may be necessary in many cases.