Exercise for the Heart Patient, for Postop Patients, and for the Hospitalized - When not to exercise

Many heart attack patients cannot wait to get started on an exercise program. They may not understand that when a physician advises against exercise of any kind, or prescribes very light exercise at the beginning of a program, he usually has reasons that relate to the condition of the patient's heart.

In myocardial infarction, for instance, a scar forms on the heart. The scar may take as long as six weeks to heal. Exercise taken before the healing process has been completed may cause the heart wall to bulge, forming an aneurysm. The bulging can occur with each heartbeat and can lead to additional serious heart problems.

If a patient has experienced an acute myocardial infarction, a relatively rare occurrence, either the right or the left sides of the heart may be seriously affected. Exercise may not become permissible until complete recovery of pump efficiency has taken place. The period may last for two or three months or more.

An aneurysm in one of the large blood vessels, such as the aorta, may preclude vigorous training for a period of weeks or months.

A patient who senses rapidly progressing anginal pain while exercising may be receiving warnings of another heart attack. Normally, he should stop exercising at once and not resume until he has medical clearance.

A generalized infection of the heart area can accompany such major diseases as rheumatic fever or diphtheria. Infection may also occur with viral problems such as poliomyelitis, influenza, or infectious mononucleosis. The heart involvement, known as myocarditis, makes exercise hazardous, especially where the patient is feverish. A doctor may suggest that the patient wait a week after his temperature returns to normal before resuming his exercise regimen.

Irregular heart action may lead to serious and even fatal ventricular fibrillation, or rapid, irregular contractions of the heart muscle. Fibrillation always precludes additional exercising until the normal heart action can be restored through use of medication. Mild rhythm irregularities may not, however, be considered serious enough to terminate a training program.

Other types of heart problems that may necessitate cessation or modification of an exercise program include some types of valvular heart disease, blood clots in the lungs or peripheral arteries, repetitive heart failure that leads to enlarged heart, and complete heart block. Hypertension that cannot be controlled by medication may indicate that exercise will drive the blood pressure up higher, possibly to dangerous levels. Some forms of congenital heart disease make exercise inadvisable.

In still other cases a physician who recommends that a patient avoid exercise may be basing his judgment on noncardiac conditions. Heavy exercise may, for example, be contraindicated where the patient has severe uncontrolled diabetes. The same may be true of patients with epilepsy or narcolepsy, a tendency to experience sudden, uncontrollable attacks of sleepiness. Because exercise increases the demands made on the lungs, kidneys, and liver, exercise may be ruled out if the patient has kidney or lung diseases, tuberculosis, or other conditions affecting these vital organs.

Inappropriate exercise can aggravate other diseases and physical problems. Those falling in this category include some types of arthritis; chronic low-back trouble, a complaint that may be exacerbated by jogging; anemia; and some relatively rare kinds of neurological, muscular, or glandular diseases.