Heart Sense Helpathon: Third in a Series

Exercising Basics: Getting Started  

In the previous two guest posts on exercise, Jody Schoger and Brian Mossop inspired us with their stories of building and sustaining a rigorous exercise program.  Both promised that if you exercise regularly, you will never want to go back to being a couch potato. Exercise makes you feel better and has many health benefits.  For those of us who have experienced heart failure, the main reasons to exercise are to strengthen our hearts and the muscles in our legs, arms, and core of our bodies.

But the idea of walking, running, or biking for miles if you are unsteady on your feet or still get fatigued easily, may seem out of the question.  So let’s talk about how to get started and what types of exercise to do.  Please be sure to get your doctor’s approval before you begin exercising.  Much of the following is excerpted from Chapter 13 “Exercise:  How Much and What Kind” in Living Well with Heart Failure, the Misnamed, Misunderstood Condition the book I co-authored with Edward K. Kasper MD.  While the entire book was a collaboration, the exercise chapter was one I researched and wrote and the main references are listed below.  

If you are not already exercising regularly, why not start today.  Let’s make 2011 a year we build our strength and fitness.

Why Exercise?

To keep from turning into a statue; gain more freedom of movement; ease your heart’s workload; strengthen your core body, legs, arms, heart, and lungs; and become more active.  The main symptom of heart failure is an inability to exercise for long, or even do normal activities such as walking or bathing without feeling fatigued or short of breath.  Heart failure doesn’t just affect your heart.  It also affects many of the muscles in your body, and muscle weakness is often most noticeable in your legs. 

At least three things contribute to your muscle weakness:  As your heart labors to send oxygen to your body, your skeletal muscles receive less oxygen, certain damaging chemical changes occur, and using the muscles makes them tire easily.  Your symptoms of heart failure – your general fatigue, shortness of breath, and muscle fatigue —  often lead to your becoming less active.    Randy Rocha, strength and conditioning coach who has worked with me, explains that with inactivity, as can happen when people first develop heart failure or have moderate to severe heart failure,  muscle tightening and muscle atrophy set in.  “You atrophy so much that you don’t have the strength to get from Point A to Point B,” he says. “Not only is everything atrophying, everything’s tightening up and it’s slowly getting tighter and tighter.”  Then when you try to get up from a chair or off the toilet or walk upstairs or even walk on a flat surface, your shrunken muscles can’t meet the demands you ask of them.  So you may find yourself hobbling along, stopping to rest your hands on the back of a chair, or leaning against a wall.  Not the shape you want to be in?  Regular stretching and strengthening exercises will help you get up more naturally and walk more normally with better posture for longer periods. 

Heart Sense Helpathon

Most heart failure occurs in people who are over 55 and so, aside from your heart failure, you also may have gotten out of shape, overweight, and have some arthritis, diabetes, COVID, or other medical problems.  Now it has become very important for heart patients to test themself regularly against COVID, this can be done at home with the use of the rapid test, learn more about the rapid tests at https://clinicalsupplies.com.au/collections/rapid-antigen-tests

I was fortunate enough to get through my bout with heart failure and come out with a heart that is working normally.  But separately from heart failure, I’ve developed a neuromuscular problem that makes walking challenging.  Like me, you may have multiple reasons to exercise. When you plan your exercise routine, treat your heart failure, but also take care of your whole body’s needs.  Besides gaining the ability to be more active and do more things, benefits from exercising include lower blood pressure and improved ability of the blood vessels to expand and contract.

Types of Exercise

If your doctor says you are healthy enough to exercise and have no particular exercise restrictions, choose a combination of these four types of exercise:

1.  Stretching exercises will isolate individual muscles, lengthen them, and keep them and your joints flexible.

2.  Aerobic exercise, also called cardiovascular exercise, such as biking, walking, or running will build the heart’s endurance and improve muscle function in your legs and arms, depending on the exercise you do. 

3.  If you are strong enough, balance exercises such as standing on a balance board or wobble board will improve your body’s awareness in space.  

4.  Resistance exercises or strength training can strengthen muscles throughout your body, increase muscle endurance, and improve balance and posture.  Increasing muscle endurance can increase the body’s ability to burn fat throughout the day.

We will discuss stretching, aerobic, and balance exercises in this post and save resistance exercises for the next one because there is much to understand about how to safely do resistance exercises.

If you still have an active heart condition, the safest and most effective way to start your exercise program is to learn exactly what to do at a cardiovascular rehabilitation program or exercise center.  If your heart problem is resolved or if you don’t have a heart condition and are exercising to be healthy, you may want to go to a sports therapy center to learn how to build your personal exercise program.  Please get instructions on how to do stretching exercises.  Once you’ve learned what to do, you can work out on your own at home or you may choose to make regular visits to an exercise center.

These are some basic questions to ask a therapist or trainer:    

What exercises should I do?

In what order should I do them?  

How long should each exercise last? (How many repetitions?)

How frequently should I do each exercise?  (More than once a day?  Every day?  Two or three days a week?)

How long do I need to rest between exercises or between exercise sessions?  The right workout/rest ratio is important for people with active heart failure.  Start with short exercises and progress as you get stronger.

How will I know when to progress to more intensity with my exercises?

Stretching exercises. Before doing your stretching exercises, ride your stationary bike or walk for five minutes.  After a short warmup, you will get more benefits from stretching your muscles.  Stretching your calf muscles in your lower leg, your quadriceps — the major muscles in the front of the thigh, and hamstrings in the back of the thigh is important for walking well and not tiring easily.  Stretching the muscles surrounding the hips – glutes, hamstrings, and the iliotibial band — can help reduce back pain and improve posture.  You will hold each stretch for 20 to 30 seconds. 

Aerobic (cardiovascular) exercise. Examples are biking outdoors or riding a stationary bike, walking outdoors or on a treadmill, running or jogging, and using an elliptical trainer. These exercises, which you’ll spend the most time at, get your heart rate up. They also burn fat and help you lose weight. A recent study found that aerobic exercise helps remodel an enlarged left ventricle to more normal size.

Walking 20 to 30 minutes a day is a great aerobic exercise if you can manage it.  You may want to have a regular time each day to walk outside with a friend.  Walking in a grocery store is a good way to get started.  If you need some support when you walk, pushing a grocery cart acts as a great walker on wheels. 

If walking is difficult for you because your legs are weak, your balance is not as good as it used to be and you may fall, your knees are painful, or it’s too hot, too cold, or even icy out or the air quality is poor, there are aerobic exercises that you can do at home.  Riding a stationary bike is a good one.  Stationary bicycles and elliptical trainers are non-impact machines because there’s no pounding on the ankles, knees, hip joints, or spine. 

You can monitor your heart rate by wearing a heart rate monitor.  Some exercise machines have built-in heart rate monitors. You can also use the old-fashioned, low-tech method of counting your heart rate at your pulse.  Your target heart rate for aerobic exercise should be set by your doctor or an exercise specialist who communicates with your doctor. Your rate will relate to your medical condition and the type of shape you’re in.

Biking requires a lot of lower extremity strength, especially the quadriceps.  As you exercise targeted muscles, the heart sends blood and therefore oxygen to that muscle group.  Aerobic exercise also decreases your resting heart rate and your blood pressure.  Exercising your heart challenges it which helps it do a lot better when it’s not challenged.

Balance exercises.  Exercises such as standing on a balance board or wobble board are important because balance plays a role in stability and strength.  If you don’t have a good balance, something needs to assist you.  You’re going to focus more and use muscles a lot harder than a person who has good balance, or you will hold on to something such as a cane, a crutch, or a walker to take the stress off.  Randy says that, unless you have an injury, if you use a walking aid, what you are doing is making up for your lack of balance and strength. 

If you use a balance board or wobble board, please place it very close to a railing or other sturdy structure that you can grip to keep from falling.  You should also place the board on a rubber mat or rubber floor to help keep the board from slipping.

You can do balance exercises without using a balance board or wobble board.  Stand close to something you can hold onto such as a railing or the back of a sturdy chair in case you start to fall.  Try standing on one foot, standing on one or both feet with your eyes closed (but hold on to something or have someone stand next to you if you close your eyes), or practice marching, lifting one leg at a time, eyes open.

Start with short exercises and build to longer ones. Just get started.  Do a little each day and I think you’ll want to do more.  


  1. Kerry J. Stewart Ed.D, Director of Clinical and Research Exercise Physiology, Johns Hopkins University School of Medicine.
  2. Randy W. Rocha, Director of Sports Medicine, Metro Orthopedics and Sports Therapy Centers, Maryland.
  3. American Heart Association Science Advisory, Resistance Exercises in Individuals with and without Cardiovascular Disease: 2007 Update.
  4. ExTraMATCH. “Exercise Training Meta-Analysis of Trials in Patients with Chronic Heart Failure,” British Medical Journal 328 (2004): 189.
  5. Stewart, K.J. “Cardiac Rehabilitation Following Percutaneous Revascularization, Heart Transplant, Heart Valve Surgery, and for Chronic Heart Failure.” CHEST 123 (2003): 2104-2111.
  6. HF-ACTION.  “Efficacy and Safety of Exercise Training in Patients with Chronic Heart Failure,” JAMA 301(2009): 1439-1450.