Exercise Can Strengthen a Failing Heart

by Debra Wood, RN

Charles Holmes was rather surprised when his doctor recommended exercise to aid his failing heart, but walking and cycling in a cardiac rehabilitation program has dramatically improved his life.

"At first I was worried it might be too much for my heart to handle," said Holmes, 57, of Orlando, FL. "But it was all right. It's excellent. I feel so good, better than I did before my heart problems."

Making Exercise Routine

In the past, Holmes rode a bicycle once in a while, but he never adhered to a structured exercise plan. Patty Harper, RN, coordinator of the Cardiac Rehabilitation Program at Orlando Regional Medical Center started him off slowly.

"Our goal is to gradually increase the workout as a patient's stamina improves," Harper said. "Exercise doesn't have to be strenuous to be beneficial. A lot of times it improves the patient's ability to perform activities of daily living, like dressing and cooking, which in turn improves their quality of life."

Harper helps patients identify activities they enjoy and can continue doing at home. They learn how to manage their condition, while building endurance.

"My health has improved tremendously," Holmes said. "If I hadn't done the exercise, I don't think I would have made it. I don't get as tired as I used to. I've built up my stamina."

Congestive Heart Failure

Congestive heart failure (CHF) occurs when the heart does not pump blood effectively. Fluid backs up into the lungs and tissues. People with this condition feel tired and short of breath.

Nearly five million Americans suffer from CHF. Each year, 550,000 more learn they have the disease. Many, like Charles, discover exercise not only helps them feel better but also improves heart function.

The benefits of physical activity after a heart attack have long been recognized. But exercising with heart failure is relatively new advice. The American Heart Association guidelines for managing the disease encourage moderate exercise, such as walking or bike riding, in addition to taking prescribed medications and avoiding salt.

Proven Results

Research published in Circulation: Journal of the American Heart Association indicates that CHF patients who exercise live longer and require fewer hospitalizations than those who do not.

"Exercise training is beneficial," says one of the study authors, Demetrios Georgiou, M.D. He is an assistant clinical professor of medicine at Columbia University College of Physicians and Surgeons, New York. "We not only saw an increase in myocardial perfusion (blood flow in the heart muscle), we also showed an improvement in survival."

Dr. Georgiou explains that exercise significantly improves collateral circulation, which is small blood vessels that develop to reroute blood to the heart muscle. Three times a week, patients in his study walked on a treadmill for 40 minutes. Tests before and after showed additional blood flow to the heart. He assessed patients' quality of life and learned that those exercising felt less tired than those who did not work out. According to Dr. Georgiou, even twice weekly exercise improved heart function, but daily activity may be better.

"The compliance rate was 90% to 95%," Dr. Georgiou says. "Patients liked doing it. It was hard initially, if they had been living a sedentary life. But if they can get over the first couple of weeks, they start feeling better and like it."

When To Exercise

Patients can usually begin exercising when their CHF has stabilized. That occurs when these two criteria are met:

Heart rate is not too fast
Lungs are clear of fluid

Always check with your doctor before starting any exercise program. Your doctor may order a stress test before giving the go ahead.

"Patients should start slowly and increase the work load gradually," Dr. Georgiou advises. "Initially, the first phase should be done under supervision."

Supervision includes a cardiac rehabilitation program, like the one Holmes attends. Patients warm up before working out and they stretch their muscles after. A cardiac monitor checks heart rate and rhythm. Blood pressure is assessed before, during, and after exercising. Later on, participants learn how to check their own pulse.

"Patients usually love the security and education," Harper said. "They see their progress and enjoy the camaraderie of being with other people in a similar situation."

When not working out at the hospital program, Holmes walks on a treadmill or rides his bike. He plans to make regular exercise a part of his life. By doing so, he will enjoy a more active and healthful lifestyle.

"I'd never be doing this well without the program," Holmes concluded. "If you have a heart problem, this is the way to go."

RESOURCES:

American Heart Association

National Heart, Lung, and Blood Institute

References:

Belardinelli, R et al. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999; 99 (9): 1173-1182.