HEART FAILURE AND EXERCISE
JOHN MUIR HEALTH
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Why Exercise?
How Often Should I Exercise?
What Should My Home Exercise Program Include?
Home Exercise Daily Log
Taking Your Pulse
Rate of Perceived Exertion Scale
Exercise Session Review
Cardiac Conditioning and Pulmonary Rehabilitation
INTRODUCTION
Exercise is an important factor in managing heart failure
and improving cardiovascular fitness. Your doctor will
advise you when it is safe to start an exercise program.
WHY EXERCISE?
Regular exercise has many benefits. Aerobic, or cardiovascular exercise, can:
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Strengthen your heart and cardiovascular system
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Reduce your heart disease risk factors, such as high blood pressure and being overweight
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Improve your circulation and help your body use oxygen better
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Build energy levels so that you can do more activities without becoming tired or short of
breath
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Improve balance and joint flexibility
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Help reduce stress, tension, anxiety and depression
H OW O F T E N SHOULD I EXERCISE ?
To achieve maximum benefit, your eventual goal is to exercise three to four times a week, for
20-30 minutes per session. Every other day is a good rule of thumb.
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WHAT SHOULD MY EXERCISE PROGRAM INCLUDE?
Every exercise session should include a warm-up, a conditioning phase and a cool-down.
1. The warm-up helps your body adjust slowly from rest to exercise. A warm-up reduces the
stress on your heart and muscles by slowly increasing your breathing, circulation (heart rate)
and body temperature. It can also improve flexibility and reduce muscle soreness.
The best warm-up includes stretching, range of motion activities and beginning the activity at a
low intensity level.
STRETCHES FOR THE MAJOR MUSCLE GROUPS
Hold each stretch for 15 seconds for warm-ups and 30 seconds for cool-downs. Do NOT
bounce or jerk. Stretch slowly. Do NOT stretch through pain. Leg stretches can be done on the
floor or on the bed.
Shoulder and Upper Back Stretch
Reach overhead and slightly back with both arms. Keep your
shoulders and neck aligned and your elbows behind your shoulders.
With your palms facing the ceiling,
turn your fingers inward.
Take a deep breath. Breathe
out and lower your elbows
toward your buttocks. Hold
for 5 seconds, then return to
starting position. Repeat 3
times.
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Shoulder Clock
Imagine that your right shoulder is the center of a clock. With your
shoulder slowly trace the outer edge of the clock. Move clockwise first,
then counterclockwise. Repeat 3 times. Switch shoulders.
Side Stretch
Shoulder Girdle Stretch
Place one hand on the outside
elbow of the other arm. Pull the
arm across your body. Hold for
20 seconds. Switch sides.
Shoulder Squeeze
Raise your arms to shoulder
height, elbows bent and palms
forward. Move your arms back,
squeezing your shoulder blades
together. Hold for 5 seconds.
Return to starting position.
Stretch your right arm
overhead. Slowly bend to the
left. Don’t twist your torso.
Hold for 20 seconds. Return to
starting position. Repeat 2
times. Switch to the other side.
Shoulder Shrug
Raise both of your shoulders
as high as you can, as if you
were trying to touch them to
your ears. Keep your head and
neck still and relaxed. Hold for
a count of 5. Release. Repeat 5
times.
Neck Flex
Rest the back of your left hand against your lower back. Place
your right palm on the top of your head. Gently pull your head
forward and down until you feel a stretch in the neck muscles.
Don’t force the motion. Hold for 20 seconds, then return to
starting position. Switch arms.
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Seated Rotation
Fold your arms, elbows just below shoulder height. Turn
from the waist with hips forward. Turn your head last. Hold
for a count of 5. Return to starting position. Repeat 5 times.
Switch sides.
Hamstring Stretch
Single/Double Leg Pull
Pull one knee to your chest. Hold for 20
seconds. Then release. Repeat 2 times.
Switch legs. For a double leg pull, pull
both legs to your chest at the same time.
Repeat 2 times.
Put a towel behind one knee or calf. Use
the towel to pull the leg toward your
chest, keeping the leg straight or slightly
bent. Hold for 20 seconds. Then lower
the leg. Repeat 2 times. Switch legs.
Hip Rotator Stretch
Rest your right ankle on your left knee. Place a
towel behind your left thigh and use it to pull the
knee toward your chest. Feel the stretch in your
buttocks. Hold for 20 seconds. Release. Repeat 2
times. Switch legs.
Lower Back Rotation
Drop both knees to one side and turn your
head the other direction. Keep your
shoulders flat on the floor. Hold for 20
seconds. Switch sides. Repeat 2 times.
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2. Aerobic exercise produces the most benefits for your heart. These exercises include
activities like walking, cycling, rowing, low-impact aerobics or water exercise.
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QUICK TIPS
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Wait at least 1 1/2 hours after eating a meal before exercising.
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Dress in comfortable clothing and wear supportive footwear.
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When drinking liquids during exercise, remember to follow your fluid restriction
guidelines.
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Start slowly, then begin to gradually increase your exercise intensity.
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Check your pulse rate before, during and after each exercise session. Your pulse rate should
not exceed 10-30 beats above your resting pulse rate. Remember, some medications may
slow your heart rate. (See pulse counting illustration, page 36)
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Make a daily log of your activity and responses to the exercise. (See exercise log, page 35)
Bring this record with you when you visit your physician.
With your doctor’s approval, use the guide below to help start a home exercise program. If you
are new to exercise, begin by exercising in 3-5 minute bouts, four times a day as indicated on
the chart below.
Week of Exercise
Frequency (times/day)
Time (duration in minutes)
1st
4
3 to 5 minutes
2nd
4
5 to 7 minutes
3rd
3
7 to 10 minutes
4th
3
10 to 12 minutes
5th
2
12 to 15 minutes
6th
2
15 to 17 minutes
7th
1
17 to 20 minutes
8th
1
20 to 30 minutes
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DAILY LOG OF MY HOME EXERCISE PROGRAM
Date
Resting Pulse
Exercise
Pulse
Time
Perceived
Exertion
Comments
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TAKING YOUR PULSE
1. Place the tips of your index and middle fingers on the palm side of your other wrist, below
the base of the thumb. Or, place the tips of your index and middle fingers across the crease
between your upper and lower arms.
2. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You
may need to move your fingers around slightly up or down until you feel the pulsing.
3. Look at a watch or clock with a second hand.
4. Count the beats you feel for 10 seconds. Multiply this number by 6 to get your heart rate
(pulse) per minute.
Your pulse: _______________ x 6 = __________________
(beats in 10 seconds)
(your pulse for 1 minute)
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RATE OF PERCEIVED EXERTION SCALE
If you are unable to monitor your pulse, use the Rate of Perceived Exertion Scale (RPE).
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Stay in the green zone (numbers 11-13).
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You should be able to talk while you are exercising.
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No huffing and puffing. Stay with a comfortable push.
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Have fun! Choose an activity that you enjoy.
6
7
Very, very light exertion
8
9
Very light exertion
10
11
Moderate exertion
12
13
Somewhat hard exertion
14
15
Hard exertion
16
17
Very hard exertion
18
19
20
Very, very hard exertion
STOP EXERCISING AND CALL YOUR DOCTOR IF YOU:
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Have chest pain or feel dizzy or lightheaded
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Feel burning, tightness, pressure or heaviness in your chest, neck,
shoulders, back or arms
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Have unusual shortness of breath
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Have unusual increased joint or muscle pain
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3. The cool-down phase allows your body to recover from the conditioning phase. In order to
cool-down, slowly decrease the intensity of your activity. This will allow your heart rate and
blood pressure to return to near resting values. Do NOT sit, stand still or lie down right after
exercise. This may cause you to feel dizzy, lightheaded or to have heart palpitations (fluttering
in your chest).
Use some of the same stretches in your cool-down that you used for warm-up. Take one last
pulse count and pat yourself on the back!
EXERCISE SESSION REVIEW
Every exercise session should include a warm-up, a conditioning phase and a cool-down.
Start with a Warm-Up
Start with a 5 to 10 minute
warm-up that includes both
stretching and your chosen
exercise. Warming up raises
your heart rate slowly and
loosens your muscles.
Exercise at a slow pace for 5
minutes and stretch for 5
minutes.
Get Your Heart Going
Cool-down and Stretch
Moderate intensity exercise
does the most good for your
heart. Exercise at a brisk pace.
At first, 10 minutes may be all
you can do. In time, you should
be able to exercise at least 30
minutes a day. After this part of
your routine, be sure to cooldown.
Cooling down lowers your
heart rate and blood pressure
slowly. This helps keep you
from getting lightheaded.
Cooling down also helps you
recover from exercise. Do your
chosen exercise at a very slow
pace for 5 minutes. Then
stretch for 5 minutes.
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CARDIAC CONDITIONING AND PULMONARY REHABILITATION
If you are interested in getting additional assistance with your exercise program, ask your
physician to recommend Cardiac Conditioning or Pulmonary Rehabilitation. The Cardiac
Conditioning and Pulmonary Rehabilitation exercise programs provide a protected
environment and medical supervision to:
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Increase your physical strength and cardiovascular fitness
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Help you perform daily living activities
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Reduce your need for future hospitalization
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Reduce your anxiety about heart failure
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Give you a peer support group
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Give you more self-confidence
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Reduce risk factors
Rehabilitation nurses and exercise specialists set achievable goals and tailor a series of
exercises to each patient’s abilities. The exercise sessions require a doctor’s referral. Not all
insurances will pay for this program but self-pay rates are available.
For more information call:
John Muir Cardiac Conditioning:
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Brentwood Campus — (925) 308-8140
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Concord Campus — (925) 674-2200
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Walnut Creek Campus — (925) 947-5254
John Muir Pulmonary Rehabilitation:
Concord Campus — (925) 674-2351