The best exercise in early Cardiac Rehab

After having a heart attack, heart surgery or a heart rhythm procedure, then being told you now need to start exercising again, can be scary. You have no idea if you can push yourself, if it is safe to get your heart rate up, if you will do any damage to your heart and if getting out of breath is a sign that you will have another heart attack.

Understanding which exercises are good for cardiac rehab and learning the safe way to exercise is key.

Even in the early days post-hospital discharge, starting to be active is important. The best exercise and your first steps of cardiac rehab are to literally to walk around. This will help stimulate your cardiovascular system. This is your heart, lungs and blood supply to your body. You may still be feeling the effects of an anaenestic so you are still tired and bruised, but gentle moving of the muscles and joints will aid your recovery.

The best exercises in early rehab (at discharge) are:

1. Walking – start slow and build up to 30 minutes by 4-6 weeks
2. Shoulder shrugs / rolls – if you have had your chest opened up or a pacemaker/ICD inserted, you need to keep shoulder/arm movements to a minimum for the first 6 weeks. Start by shruging your shoulders and then small and gentle shoulder rolls. After a week or so you will be able to do bigger shoulder rolls, just make sure you are not taking your arms out sideways or doing arm circles.
3. Neck stretches – you will need to keep your neck mobile so look down, turn your head sideways, look down to the diagonals and bring your ear to shoulder. Do not look up and tilt your head back.
4. Ankle circles and point & flex – keep your ankles mobile by circling the foot.

A study was done about lifting items no heavier than a kettle for the first-week post-sternotomy (for CABG, Valve Repair or replacement, or other surgery), and the new advice is to ‘Keep Your Move In The Tube’. You can lift and carry items as long as they are close to your body, in a tube. This is a really good video explaining this technique – Keep Your Move In The Tube.

You can do basic things like carry your dinner plates into the kitchen, start to do some step-ups on your bottom stair, and even seated extended legs. When you are boiling the kettle you can do small marches on the spot.

The best exercise pre-Phase 3 Cardiac Rehab

In the 4-6 weeks post-event you should be aiming to walk for 30 minutes a day continuously. During the Phase 3 cardiac rehabilitation programme you will be increasing the intensity of your exercises as well as the duration achieving 20 minutes of continuous cardiovascular exercise.

Effective and safe, and therefore the best exercises, are those that involve the largest muscles in the body, i.e. the legs. Walking, sit-to-stands (squats), steps, hamstring curls (kick your bottom), touchbacks, sidesteps and calf raises.

There is a danger of your heart rate and blood pressure increasing too high if you only perform arm exercises. Therefore these are only advised when moving the feet at the same time.

The best exercise in Phase 4 Cardiac Rehab

In Cardiac Lauren there is a mix of the best exercises. Phase 4 with Cardiac Lauren is ‘exercise for life’ and a continuation of the cardiac rehab journey. This means everyone can continue to progress at their own pace and to be able to extend the cardiovascular workout to 30 minutes of continuous exercise in one session.

See this example of the different ways in which you can perform one of these best exercises, the touchback.

Ideally, the best exercises are performed standing so we can keep our feet moving to help pump the blood back up to the heart which means you do not need to work your heart so hard. Seated options are available as long as the feet move all the time.

If you perform the exercises as arms and legs together this means you can add cardiovascular and resistance which is beneficial to your fitness.

Most of the best exercises are safe, but you should avoid changing your position from standing, to seated, to lying to standing etc, so don’t do touchbacks then straight down to the floor for abdominal exercises and back up for knee raises. With the side effects of your medication, and your heart rate and blood pressure up, you could pass out. Following a structured class like those in Cardiac Lauren will ensure you are exercising safely and incorporating the best exercises into your routine.

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The 4 phases of cardiac rehabilitation refer to the steps and interventions an individual moves through from the immediate diagnosis of a heart condition, through to maintaining a safe, fulfilled and active lifestyle in the long term.

Phases 1-3 of cardiac rehabilitation are finite steps, i.e. the individual aims to graduate to the next phase over time, depending on their progress and medical advice. Phase 4 is intended to facilitate the long-term benefits of consistent exercise while living with a heart condition. Patients build their fitness gradually and safely – to both lower the risk of future heart events and to join a friendly and knowledgeable community of people. There is no ‘completion’ of Phase 4 – it is there to support and engage you in the long term for its mental, physical and social benefits.

What is Phase 1 of cardiac rehabilitation?

Phase 1 refers to the acute stage of the heart condition, and often, it starts from a person’s diagnosis following the heart event. Most cardiac rehabilitation patients will have been admitted to the hospital during Phase 1 – after having had the heart event (myocardial infarction) which may have been called acute coronary syndrome on the discharge notes. During Phase 1, the main goals of recovery are as follows:

• To stabilise the patient so that the symptoms do not worsen

• To prevent further damage to the heart

• To initiate treatments to help the heart muscle recover

The length of Phase 1 rehabilitation depends on the nature of the condition and the extent to which the heart has been damaged. Each person is different, and while one person may respond to initial treatments immediately, others may take longer. It is therefore important to try and be patient while in Phase 1; the lack of control can be frustrating, but the most important thing is that you don’t rush the process.

What is Phase 2 of cardiac rehabilitation?

Phase 2 occurs after Phase 1, outside of the hospital setting. It is when patients who have suffered a heart event are discharged from the hospital, return to the care of their GP (General Practitioner) and are thereby classified as ‘outpatients’. However, people who have had surgery, CABG and valve repair or replacements in particular, will have the district or cardiac specialist nurse attend their homes or have appointments with them, so that any lacerations resulting from surgery can be looked after. If you had stents fitted then you will have been given verbal and written information about the early days of your recovery when at home.

For most Phase 2 patients, discharge summary notes from the hospital will have been forwarded to the local NHS cardiac rehabilitation team and they will make contact by phone. At this initial contact, the patient will be able to ask questions and get advice about taking pain relief, what joint mobilisation and muscle stretches to do, and how to cope with things like coughing or sneezing after having a sternotomy (surgical procedure).

Phase 2 lasts for two to six weeks depending on the heart event or diagnosis. Everyone at this stage will be encouraged to keep moving around the home and start a gradual walking programme. The aim is to achieve 30 minutes of continuous walking daily by the end of the six weeks. For some people, this is easily achievable, whereas others will need longer and their goal may be to just do 10 minutes of activity each day. The cardiac rehab team sees everyone as an individual and will tailor their recovery to each person.

What is Phase 3 of cardiac rehabilitation?

Phase 3 is where you will start a comprehensive cardiac rehabilitation programme, predominantly with your local NHS team. This is different from Phase 2, where you are still recovering, understanding and adapting to your diagnosis.

In Phase 3, education, exercise and support from a multidisciplinary team are put together in a 4–12-week programme. The primary goal of Phase 3 cardiac rehabilitation is to help individuals return to their normal daily activities and improve their overall health and well-being.

Participants may attend organised sessions in their local hospital, medical centre, a local gym, or community hall to receive Phase 3 care. Some attend once a week, others twice, or more. Many people are now offered hybrid programmes of a mix of online and face-to-face classes, as well as phone apps and computer websites to guide them through the whole cardiac rehabilitation process.

The main aims of Phase III are to:

• Educate you about your condition – why it happened and how to prevent it from happening again.

• Educate and support you on any changes you need to make to your lifestyle – such as diet, stopping smoking, losing weight, exercising more, lowering stress levels, managing blood sugar levels (if you are diabetic) and reducing alcohol intake.

•  Support your mental well-being and manage anxiety and stress.

•  Encourage you to be more active in everyday life.

• Be able to achieve 20 minutes of continuous cardiovascular exercise.

•  Be able to monitor yourself whilst exercising so it remains at a safe intensity level.

•  Understand what and why you take the medication you have been given.

• Learn to live with your condition and for it to not be a reason to stop doing many of the things you did before or would like to do in the future.

In terms of exercise, some Phase 3 cardiac rehab programmes are based in a gym or have gym equipment (bikes, treadmills, rowing machines, steppers etc), whilst others will have a circuit format using weights, resistance bands, steps and your own body weight. No method is better than the other, especially as the main aim is to achieve 20 minutes of continuous aerobic exercise, and each participant will be exercising at a different intensity to the other. 

At the end of the Phase 3 programme, everyone will have a better understanding of their condition and how to live with it. For most people, apart from having to take medication daily, their lives can continue as before with the new lifestyle changes they have put in place. For some, their condition requires regular monitoring, but this does not mean they cannot continue to progress on their cardiac rehabilitation journey. If anyone is waiting for a medical procedure, being as fit and healthy as possible pre-operation is extremely beneficial and will make recovery a quicker experience.

What is Phase 4 of cardiac rehabilitation? 

Phase 4 of cardiac rehabilitation is where the fun starts! Phase 4 is a chance for you to invest in your long-term mental and physical health, in a safe manner considering your history of a heart event.

The Cardiac Lauren philosophy is that Phase 4 improves not just your overall fitness, but your quality of life. Each online class guides people with a history of a heart event through exercises where no gym membership or expensive equipment is needed. In fact, the most you will need is a chair and milk cartons if you don’t own any lightweights!

There is a diverse range of classes to choose from at Cardiac Lauren, to suit your confidence, ability and mood. You can sample seated classes, high-intensity classes, post-walk classes and many, many more.

Although some patients may feel anxious about the strain they may be putting on their heart in exercise classes, especially as they challenge themselves to harder exercise, however, Cardiac Lauren’s classes make use of RPE, which stands for Rating of Perceived Exertion (you are likely to have used this in Phase 3).

RPE is a subjective measure of how hard someone feels they are exercising – to help people gauge their intensity level during physical activity. Anywhere between RPE 11 & 14 is generally desired – i.e. ‘fairly light’ to ‘somewhat hard’.

Cardiovascular exercise strengthens the heart muscles, enabling you to feel fitter and stronger in daily life.

Phase 4 should be a fun, accessible and sustainable addition to your life, which enables you to live your life without the frustration and restrictions of your heart event history. It also decreases your likelihood of having another heart event, as your heart adapts to exercise and becomes stronger.