Times have changed vastly over the last 30-40 years. Until the 1950’s we had one treatment for a heart attack and that was basically bed rest! Nobody even thought that you should move, never mind exercise after a heart attack. Then in 1952 there was a paper published in a leading medical journal that showed if patients were allowed to sit in an armchair, rather than bedrest, they were more likely to survive hospital stay. We realized, sitting around kills! Since that time research has made one thing very clear; that physical activity is beneficial to the health and well being of people of all ages. It has been proven to reduce the risk of developing or dying from several conditions including of course, heart disease.
Based on this, both the US Department of Health and American Heart Association recommend that everyone try to do 30-60 minutes of moderate physical activity a day, which can be spread out into 2-3 segments if necessary. The fact is that people that are physically active live longer and feel better than those that aren’t. In patients with heart disease, regular physical activity reduces symptoms and improves functioning in addition to acting to combat cardiovascular risk factors such as prediabetes. In addition to aerobic activity such as walking, jogging, cycling etc, resistance training has also been shown to improve functioning and quality of life, with some studies, albeit relatively small demonstrating it is well tolerated. For this reason, guidelines for physical activity say that in addition to aerobic activity it’s reasonable for a physician to recommend complimentary resistance training at least 2 days a week.
So should you exercise after a heart attack? For those patients that have suffered a heart attack – even a severe widowmaker heart attack – daily walking should be encouraged straight away after discharge from the hospital if possible. Although it just seems obvious that exercise is good, this has been studied extensively. One study looked at a total of 9000 patients taken from a combination of almost 50 trials that studied the effect of exercise in patients with heart disease. Most people had exercise interventions for around 3 months and were followed up for about 1½ years. It was found that those that exercised had a 20% lower chance of dying and appeared to have lower rates of repeat heart attacks or need for procedures.
How Safe is Exercise after a Heart Attack?
The AHA has estimated the risk of having a cardiac event when doing supervised exercise based cardiac rehabilitation at 1 event for every 80 000 hours the patients exercised in the studies, which is remarkably low. Although it is most likely safe to embark upon an unsupervised exercise program for many of those having had a heart attack, the guidelines recommend cardiac rehabilitation programs for patients that have had a heart attack or heart disease. In these programs, participants undergo evaluation, prescribed exercise, education and attention is paid to modifying risk factors for heart disease with exercise training done in a supervised environment.
The programs are designed to limit not only the physical but also the psychological effects of heart disease. It’s been proven that these programs not only ease rehabilitation, but also enhance education and increase the chance of taking the correct medicines. In addition to aerobic training, resistance training is also incorporated usually beginning 2-4 weeks after the aerobic training is started. The benefits don’t stop there however, rehabilitation programs are associated with a lower risk of sudden death or repeat heart attack and can stabilize the disease process.
Which Exercises Are Safe After a Heart Attack?
It’s suggested that patients that are high risk should participate in a medically supervised program for 8-12 weeks at least. High-risk patients include those that have had multiple heart attacks, cardiac arrest, severe symptoms, low exercise capacity and those that have had stress tests showing significant areas of abnormality. This is the reason you often hear the phrase ‘see your Dr before initiating an exercise program’ its not just an easy way to remove liability, its actually a way to determine your risk and the setting in which you should exercise, i.e. supervised vs. unsupervised. If possible though, the monitored setting of cardiac rehab programs is preferred.
Many resources exist to guide people through just how to start their own exercise program and if you are a heart patient and aren’t active, you should strongly consider starting some form of physical activity. The fact is that those people that are the least active are those at the highest risk of dying and having other bad outcomes like heart attacks. Initiation of exercise has been shown to move people out of the lowest risk group and therefore improve chances of survival and a better outcome.
So YES – You should exercise after a heart attack – It could stop you having another!