3. 2www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Table of Contents
Introduction 3
Part 1 – Getting Started 5
Part 2 – Staying Motivated 10
Part 3 – Getting Fit 14
Summary 17
Resources 17
4. 3 www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Introduction
The only thing that may be more stressful than having a heart attack is going home from
the hospital afterwards. One thing's for sure, life's never going to be the same again.
You were likely discharged with a headful of worry, a bag full of medication and a
laundry list of to-dos: change your diet, lose weight,
control your stress and start exercising.
That’s a pretty intimidating list to take on, especially all at
once. So don’t take it on all at once! The secret is to
start with just one to-do: exercise. Exercise is one of the
best things you can do to prevent the progression of heart
disease. It can strengthen your heart, reduce your
weight, lower blood pressure and cholesterol, lessen
stress, improve sleep, and decrease your chances of
another heart attack. What's more, exercise helps you
feel good, look better and enjoy life.
All well and good, but you may be feeling apprehensive
about starting to exercise after your heart attack. After all, shouldn’t you take it easy?
What if exercise leads to another heart attack? Guess what, you are 75% more likely
to die from a subsequent cardiac if you DON’T exercise.
So where to begin?
Why Exercise?
• Strengthens your heart
• Improves
cardiovascular
functioning
• Lowers weight, blood
pressure and
cholesterol
• Helps manage stress
• Improves sleep
• Makes you feel and
look good
• Minimizes the chance
of another heart attack
5. 4www.heartgeek.com
You know you need to exercise, but you don't know how to get started, how to stay
motivated, and what kind of exercise is best. This 3-part Guide helps you answer these
questions and more.
Part 1: Getting Started – lose your excuses, get moving and begin building your
strength and endurance.
Part 2: Staying Motivated – set up long-term healthy habits, including setting
goals and rewarding yourself.
Part 3: Getting Fit – increase your strength and endurance with a mix of cardio,
interval and resistance training.
Let’s get started!
6. 5 www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Part 1 - Getting Started
Even though most of us understand the health benefits of exercising, most of us don’t
exercise regularly. I know I fell into this category prior to my heart attack. What about
you? Common sense tells us we need to get off the couch and start moving, yet we
continue to stay glued to our seats. What's holding us back?
EXCUSES!
Life's busy. All of us are doing our best to balance family, health, work and everything
else life throws at us. We think up all sorts of reasons why we can't exercise. The first
thing to recognize here is that our excuses are usually fiction. The reality is we can
decide to change our behavior. And from that moment, we can look forward to a longer
and healthier life.
Excuse Reality
I don’t have time to exercise Cut down on your TV and social media
addictions.
I’m too tired to exercise Exercise actually increases your energy
levels.
I’m too out of shape to exercise You're out of shape because you're not
exercising. If you have legs, walk.
I’m too old to exercise It’s never too late. Exercise allows you to
keep your independence as you age.
7. 6www.heartgeek.com
Excuse Reality
I get bored when I exercise Find the right exercise. Join a group and
make exercise social.
I’m a smoker, not a runner My personal favorite. You are what you
want to be. Change your mindset!
So where do you start? I'm sure a doctor or nurse made you take a few laps around the
cardiac unit before you were discharged. Great news – you've already started!
“Start where you are. Use what you have. Do what you can.”
Arthur Ashe
Don’t lose that momentum. Use the following 5 five steps to develop an exercise
program that's right for you.
Step 1: Talk to Your Doctor
You probably didn't have your doctor on speed dial prior to your heart attack. Now that
the heart attack's out of the way, it’s time to start communicating with your doctor.
They can help you determine what types of exercise are safe for you, how often to
exercise, and what your specific goals should be.
• Attend Cardiac Rehab – The hospital or your doctor will likely recommend a
cardiac rehabilitation program. These programs provide a good mix of education
and exercise. They're a great way to get over the initial apprehension you might
be feeling about resuming physical activity. Not only will these professionals get
you moving, they can also assist with quitting smoking, changing your diet and
reducing stress. Most programs last 2-3 months.
• Develop a Personalized Plan - Next, talk to your doctor about a personalized
exercise program that takes into account your condition before the heart attack
and its severity. Your doctor may want you to take a stress test before starting
8. 7 www.heartgeek.com
your new exercise program. This allows your doctor to get a good baseline of
your abilities in a controlled environment. Also talk to your doctor about
resuming sexual activity.
Step 2: Find a Buddy
The first few times you venture out after your heart attack can be scary, especially if
you're alone. Bringing a friend along on those early walks helps alleviate your
anxiety. Scheduling exercise with a friend is also a great way of holding you
accountable.
• Find a Buddy – Actually, find several. If you have a
primary caretaker at home, leave them at home (they
need a break). Find a few friends that can join you on
your regular walks. If you do walk alone, make sure
someone knows where you're going and bring a cell
phone.
• Walk and Talk – Walking is great exercise and
provides an opportunity to socialize with your friends.
Depression and anxiety are common feelings after a
heart attack. Talk to your walking buddies about what
you're going through. If you get out of breath while
walking and talking, that’s a good sign you need to
slow down the pace.
Step 3: Start Slowly
Step 3 is likely the most important step, especially if you were the stereotypical Type A
personality before your heart attack. Restraint is your friend in these early days.
• Slow 'n Easy – Start on a flat surface. Initially 5-10 minutes at a time is probably
enough. Don’t worry about how fast you go or the distance you cover in these
early days of walking. Also, if it's too hot or cold outside, try the mall. Yes, the
mall!
Sample Walking
Schedule
Week Minutes
1 5-15
2 15-20
3 20-30
4 30-40
5-6 40-60
9. 8www.heartgeek.com
• Rest ‘n Repeat – Since your walks are short, try several each day. At this stage
in your recovery even these brief walks will tire you out! Make sure you get
enough rest in between. If you feel extremely fatigued, don't walk and consider a
call to your doctor.
Step 4: Build Gradually
After your first week of walking, you should start to feel human again. The body has
started the healing process and is ready to take on a little more. A little more - don’t
start sprinting just yet.
• Add a Few Minutes – As your body regains strength and stamina, add a few
minutes to each walk. By the end of the first month you should be walking for 30
minutes at a time. You still want to walk nearly every day, but multiple daily walks
are no longer necessary. At this point too, your doctor may be discouraging
those daily naps, so pace yourself.
• Add a Few Stairs or Hills – Depending on the severity of your heart attack or
surgery, you should be able to use the stairs shortly after you return home. Take
it slowly on the stairs and rest if you need to, especially if you get short of breath.
At this point, you should also be able to incorporate gentle slopes or hills into
your walking routine.
Step 5: Add Variety
Let’s face it, you're likely bored with your walking by the end of month one. I’m not
encouraging you to leave walking behind, but it may be time to add a little variety to the
mix. Adding variety will work your muscles in new ways and make your workouts more
fun.
• Biking – A stationary bike is a good place to start since you don’t have to deal
with hills, traffic, dogs, rain, etc. The same rules established for walking apply for
biking. Keep it at a moderate pace and build gradually. The focus should be on
time, not distance. Once you have the strength, and the green light from your
doctor, it may be time to hit the open road. Regardless of whether you're on a
10. 9 www.heartgeek.com
stationary bike or a road bike, your goal is to build cardiovascular strength and
endurance, not ride your first century (100 miles).
• Jogging – Your doctor's guidance and your own common sense are required
here as well. Prior conditioning and the severity of your heart attack play a role in
determining when to start jogging. You may want to start on a treadmill before
venturing outside. Warm up with a 10-minute walk, followed by 10-20 minutes of
moderate jogging. It’s also a good idea to tack on a 10-minute walk to cool down
at the end. Increase intensity and distance with your doctor’s approval.
• Swimming – It may take a little longer before you jump back in the pool. If you
had bypass surgery, you'll likely need to wait at least 6 weeks. Again, check with
your doctor. Swimming conditions the whole body, including the cardiovascular
system. It’s also easy on the joints and can be a part of your exercise routine at
just about any age.
Understanding your limitations and frequent communication with your doctor are very
important as you start your exercise program. If you experience chest pain, dizziness or
nausea during exercise, STOP! If the symptoms don’t disappear quickly seek medical
attention.
11. 10www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Part 2: Staying Motivated
Congratulations on getting started! Believe it or not, the hard part is over. Most people
never achieve their goals for a healthier lifestyle because they just can’t get started.
With that hurdle out of the way, how are you going stick with it and stay motivated to
achieve your goals?
Most people think having a heart attack is motivation enough to change your old ways
and begin a new healthy lifestyle. After all, you have a second chance at life, so how
could you not be motivated? I get that. I also get how hard it is to break old habits and
pick up new ones.
“Motivation is what gets you started. Habit is what keeps you
going.” Jim Ryun
Let’s start with the old unhealthy habits. Even if you've started exercising and eating
better, you may still be clinging to some old habits. Here are some tips for breaking
them.
Unhealthy Habits Tips for Breaking Old Habits
Smoking
Don’t be shy about asking a doctor or
support group for help with this one.
Watching TV You don’t have to quit TV altogether, just
don’t settle in for hours of channel surfing.
Instead, set aside a small amount of time
to indulge in your favorite shows.
12. 11 www.heartgeek.com
Unhealthy Habits Tips for Breaking Old Habits
Overeating Only eat if you're hungry and learn what a
proper portion or serving size is. Be
mindful of eating because you're bored or
stressed.
Eating junk food Learn how to cook. Healthy food can also
be tasty and convenient.
Drinking excessively
Excessive or binge drinking is stressful for
your heart (and liver). Limit yourself to no
more than 2 drinks per day.
Ignoring Sleep Sleep is incredibly important for your
overall health. Go to bed and get up at a
regular time each day. 7 to 8 hours are
appropriate for most adults.
Stressing Exercise is a great way to relieve stress.
Be aware of your stress and look for
healthy ways to manage it such as deep
breathing or meditation.
Even if you're dealing with all these unhealthy habits, the easiest way to get rid of them
is to form healthy habits to replace them.
Healthy habits are the key to long-term motivation. They help you to envision yourself
as a healthy person. Healthy people do healthy things. Doing healthy things leads to
healthy habits. Before you know it, you enjoy doing healthy things, and you are a
healthy person.
Here are 5 steps to help you develop healthy habits:
13. 12www.heartgeek.com
Step 1: Set Goals
Goals need to be measurable and obtainable. For example, 'I'm gonna lose 2
pounds a month' is much more realistic goal than 'I want 6-pack abs'.
Step 2: Make a Plan
How are you going to achieve your goals? Put your
morning workouts on a calendar. Or, build exercise into
activities you're already doing. Can you walk or ride
your bike to work? Whatever your plan is, make sure
you tell other people. Accountability is likely to help with
your motivation.
Step 3: Track Performance
Take before and after pictures. They're very motivating! www.myfitnesspal.com is
one of many sites that help you keep track of your diet and activity. There's also a
lot of cool wearable technology and watches available that help track your fitness
goals.
Step 4: Provide Rewards
Recognize when you achieve goals. If all goes as planned, you may need some
new clothes. My own favorite rewards are the technology gadgets just mentioned.
Invest in a good heart rate monitor. If you don’t want to hassle with the chest strap,
there are a few new watches out there that can track your heart rate in real-time.
Step 5: Enjoy Yourself
Make sure you're doing something you enjoy. If running's not your thing, try biking
or swimming. Look into sites such as www.fitocracy.com to provide motivation and
make working out fun.
Don’t worry if you have setbacks along the way. This is hard stuff and setbacks are
inevitable. Just don’t throw in the towel when they happen. Acknowledge, them, try
Motivation Tips
• Communicate your
goals to family and
friends
• Take before and after
pictures
• Measure and track
yourself against goals
14. 13 www.heartgeek.com
and determine why they happened, and start over. Any habit takes time to develop and
the healthy ones are well worth the effort.
15. 14www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Part 3: Getting Fit
You followed your doctor’s orders, completed cardiac rehab, and gradually built up to
lengthy walks each day. You might even have mixed in a little bit of biking or swimming.
You're feeling stronger, starting to believe in the benefits of exercise, and you want
more. You're motivated all right - you want to be better, stronger, faster!
“Exercise should be regarded as tribute to the heart.” Gene
Tunney
All right, all right, settle down. It may be time to say goodbye to your walking buddies at
the mall, but you still need to be sensible. Work with your doctor to develop a more
advanced fitness program that's still safe. Your new program may include a
combination of regular cardio, interval training, and resistance or strength training.
Steady-State Cardio Training
Walking, jogging, biking, or swimming improve cardiovascular functioning and
endurance and help maintain your weight and conditioning. These forms of exercise
are known as steady-state cardio. Steady-state cardio is necessary to build the
aerobic conditioning necessary for more advanced exercise programs. It’s also
good for relieving stress. Note the following, however:
• Low-Moderate Intensity – You're not competing for Gold. No matter which
activity you focus on, training should be done at a low to moderate pace. Sprints
don’t relieve stress.
16. 15 www.heartgeek.com
• Mix it Up – There's no reason you can’t pick more than one activity for your
steady-state cardio exercise. Alternating between jogging, biking and swimming
keeps things interesting and protects your body from injuries caused by the
repetition of a single activity.
Interval Training
Interval or HITT (high-intensity interval training) is all the rage these days. However,
be careful - this is serious stuff and shouldn't be attempted until you've obtained
proper conditioning. You must speak to a doctor before starting any kind of interval
training.
Interval training is usually defined by short burst of intense activity (think sprinting up
a hill) followed by a short recovery and then a repeat. Benefits include a more
efficient cardio workout and increased weight loss due to faster calorie burn.
• Duration – Interval programs range from 4-30 minutes. Typically, you
sprint/exercise for about 30 seconds followed by a 15-second rest, and then
repeat. I have an 8-minute routine on the stationary bike that's a serious
workout.
• Intensity – Intensity is the key to interval workouts but so is the fact that you
recently had a heart attack. Instead of sprinting, you may want to start out with
30 seconds of moderate running (treadmill or outside), followed by 15 seconds of
light jogging. As you build strength and endurance, you can speak to your doctor
about increasing the intensity.
Resistance Training
Resistance training is traditionally a taboo topic for cardiac rehabilitation, and for
good reason. Lifting too much too soon can put undue stress on your heart or
surgical incisions. If you've had open-heart surgery you need to wait at least 6-8
weeks before beginning resistance training.
17. 16www.heartgeek.com
Today, there's growing support for adding resistance training - at the right time - to
cardiac rehab programs. After all, your heart is a muscle and could probably use a
little strengthening.
Resistance training can help you regain your strength and endurance (not to
mention your self-esteem). Start with bands or very light weights and go easy on the
repetitions.
• Free Weights – Go light, very light. This shouldn’t be a problem as you're likely
struggling to lift a gallon of milk after your heart attack! Bands or 1-2 pound
weights for a few reps will get the job done in the beginning. As your strength
comes back and you regain confidence, add 1-2 pounds per week. Your focus
should be on regaining strength, not getting HUGE!
• Bodyweight – Bodyweight training is great because you can do it anywhere
anytime, and you don’t need equipment. Make sure you've regained your basic
strength before graduating to these exercises. Bodyweight training works the
whole body and typically includes lunges, squats, push-ups and pull ups.
Just as with your cardio program, a weight-training program should be tailored to your
personal situation. Resistance training can enhance the benefits of your cardio program
while also increasing muscle strength and bone density. Be careful, getting ripped is a
potential side effect!
18. 17 www.heartgeek.com
Exercise After a Heart Attack
A Guide to Getting Started and Staying Motivated
Where To Go From Here
If you follow the steps outlined in this book, you will begin your journey to physical
fitness and a heart healthy lifestyle. Success doesn’t happen overnight and you should
expect a few stumbles along the way. Don’t get discouraged. Even a few small
changes in your physical activity can make a difference. Keep at it and don’t go it
alone. Share your experiences and get useful tips from others in the HeartGeek
community.
Join our community by signing up for email updates.
You can also be a fan of HeartGeek on Facebook or follow me on Twitter.
Resources
www.myfitnesspal.com
http://www.fitocracy.com
About Me: My name is Paul Maher. I'm a heart attack, cardiac
arrest, and bypass survivor and author of the blog HeartGeek. I
started HeartGeek to share my cardiac experience, recovery, and
road to wellness. My hope is that by sharing these experiences, I can
help you have a more positive recovery, enjoy a heart healthy
lifestyle, and hopefully have a little fun along the way.
