Exercise training for people with cardiovascular disease

In this article we will discuss why people with heart diseases should have physical training and how they should train. Be aware, however, that if you suffer hypertension or cardiovascular disease, consult your doctor and undergo all medical examinations and procedures before starting to train, especially if you haven’t done it before.

Physical activity for your heart health

1 of 5 cases of coronary artery disease (CAD) in developed countries is associated with low physical activity (hypodynamia). Regular moderate physical activity reduces the risk of CAD and may reduce the risk of death related to heart diseases.

Scientists from the National Heart Foundation in Australia say: “Lack of physical activity is related to less favorable survival rates among those who survived heart attack in comparison to patients who do not avoid physical activity”.

Patients with cardiovascular diseases may gain the following advantages from regular physical exercises:

Improved physiological functions

Physical rehabilitation inevitably improves objective indicators of functional capabilities (working abilities) in patients with heart diseases. Endurance exercises improve  mobility in patients survived strokes and increase the distance people with peripheral vascular diseases and limping patients are able to cover.

Reduction of symptoms

Regular training decrease recurrent symptoms of angina, reduce shortness of breath associated with cardiac insufficiency and strokes, and make limping less obvious in patients with peripheral vascular diseases.

Improved profile of coronary risk

Regular moderate physical activity lowers high blood pressure and the level of triglycerides. Exercises also increase the level of high-density lipoproteins (cholesterol protecting the heart) in patients with coronary artery disease. Besides, regular training reduce insulin resistance and increase tolerance to glucose in patient with tendency to developing diabetes.

Reduced mortality rates

Active people decrease the risk of death after a heart attack by 25% in comparison to patients who lead a passive lifestyle.

Better physical condition

Resistance trainings makes people stronger and increase self-confidence in people with cardiovascular diseases. They also help patients better deal with their routine tasks requiring physical efforts.

It is important that the effect of regular physical activity on cardiovascular health and working abilities of patients is short-lasting. As soon as a person stops doing exercises, their functional abilities dramatically decrease. Combination of regular physical activity with medical drugs improves heart health even more.

Improved quality of life

Physical rehabilitation is related to small but stable changes in the quality of life of patients after a heart attack and patients with cardiac insufficiency and peripheral vascular diseases.

Patients with heart diseases who train regularly report increased self-confidence, depression and anxiety reduction. They have a sense of well-being and, what is more important, they do not feel social isolation.

How physical training can help people with heart diseases

The American College of Sports Medicine (ACSM) reports that regular anaerobic training reduce heart rate and lower blood pressure both at rest and during physical activity. As a result, pressure on heart is reduced and unpleasant symptoms of angina are not so pronounced.

Regular training makes the muscles stronger, enhance transport of oxygen to the tissues. As a result, patient feels more energetic and gets tired less. This is very important for people with heart disease whose aerobic parameters are worse than in healthy people of the same age. Interestingly, better improvements are observed in people with the poorest physical capacities.

Contraindications for exercises in patients with heart diseases

ACSM guidelines for pre-exercise screening and development of training program describe contraindications for exercises in patients with cardiovascular diseases.

Contraindications for exercises in patients with cardiovascular diseases:

  • Unstable angina
  • Uncontrolled hypertension with systolic pressure >180 mm Hg and/or diastolic pressure >10 mm Hg at rest
  • Orthostatic hypotension (systolic pressure >20 mm Hg and/or diastolic pressure >10 mm Hg) with such symptoms as dizziness, nausea, weakness, blurry vision, loss of consciousness
  • Severe aortic stenosis
  • Uncontrolled atrial or ventricular arrhythmia
  • Sinus tachycardia (heart rate >120 bpm.)
  • Uncontrolled cardiac insufficiency
  • Third-degree atrioventricular blockade in patients without cardiac pacemaker
  • Active pericarditis and myocarditis
  • Recent history of embolism
  • Acute thrombophlebitis
  • Exacerbated chronic disease or fever
  • Uncontrolled diabetes
  • Thyroadenitis, hypo- and hyperkalemia, hypovolemia
  • Severe orthopaedic disorders that prevent patient’s activity

If you have one or more of these conditions, you should avoid training.

How and how much people with heart diseases should exercise

If there are not contraindications for training, a patient can gradually increase their physical activity under a specialist control. It is a medical specialist who must approve the type of physical activity, its frequency and intensity. Training should be appropriate for a physical condition of a patient with cardiovascular disease not to do any harm.

Aerobic exercises

Scientists from ACSM believe that the best aerobic exercises for people with heart diseases are walking, workout on the elliptical machine or stationary bike, and stair climbing.

Significant improvements may be observed when patients with heart diseases do aerobic workout 3 times a week during at least 12 weeks. If patients train more frequently, the improvements are even better.

Australian specialists recommend the patients with stable health condition spend 30 minute or more a day for training most days of the week or even every day.

The duration of aerobic training for people who do not have any contraindications is 30 minutes. Patients have 2 options: they can have one half an hour training or have 3 training for 10 minutes.

Taking into account the results of pre-exercise screening (performed by a doctor or a qualified specialist), ACSM recommends training with 40-80% intensity the levels of which are based on % of Heart Rate Reserve (HRR).

Heart rate reserve is the difference between resting heart rate and maximum heart rate.

How to measure training intensity level:

  1. Determine maximum heart rate by substracting your age from 220.
  2. Determine your heart rate per minute at rest.
  3. Calculate the difference between maximum heart rate and heart rate at rest.
  4. Calculate the intensity using the Karvonen formula:

For example, let’s calculate training intensity at the level 50% for a person of 60 years old and heart rate 65 bpm at rest.

Target heart rate zone = % intensity x heart reserve + heart rate at rest.

Maximum heart rate: 220 – 60 years old = 160 bpm.

Heart rate reserve: 160 – 65 (heart rate at rest) = 95 bpm.

Total: 65 (heart rate at rest) + 50% intensity x 95 bpm. = 112 bpm.

112 bpm is approximate heart rate for training.

How to choose intensity without making calculations

Scientists from the British Heart Foundation say that intensity of physical activity should make heart rate faster and a person starts breathing more heavily. At the same time, a person should be able to keep the conversation. If a person is not able to speak during anaerobic training, then the intensity is too high.

Some patients with heart diseases are not able to keep up with these recommendations about duration and intensity of physical activity. However, at least some physical activity is needed. Patients can start with 5-10 minutes walking in a slow pace, this is better than no activity at all.

Resistance training for patients with heart diseases

Resistance training is an effective and safe way to increase muscle strength and endurance in patients with clinically stable coronary artery disease. Resistance exercises on the upper part of the body improve functions of cardiovascular system due to lower blood pressure and heart rate. Consequently, such exercises help to slow down the heart activity when working and doing daily routine.

The specialists from the Department of Cardiological Rehabilitation and Cardiovascular Studies say that resistance training is especially important for the weakest patients who feel weakness in their feet and have difficulty in doing aerobic exercises.

Training equipment:

For resistance exercises, it is good to use resistance bands, machines and even free weights such as bar-bells and drum-bells.

Exercise recommendations:

  • Lift and drop weight under full control,
  • Try not to hold your breath,
  • Avoid too much tension and straining,
  • Do not squeeze the grip of a bar-bell or a machine too much as it can cause a pressure jump.

Intensity and amount of exercises:

A person should be able to make 10-15 reps without too much straining at the level of about 30-40% from one maximum for the upper part and 50-60% of the maximum for the lower part (it is prohibited to use your maximum for people with heart disease! It is necessary to measure it using a strength calculator. Anyway, training to failure is prohibited for people with heart diseases). Increase working weight not more than for 1-2 kg for the upper part and 1-4.5 kg for the lower part but only in case you are able to make 15 reps without too much strain.

At the beginning, do only one set of exercises for major muscle groups (arms, shoulders, chest, back, buttocks, abdomen and feet). It is recommended to do 8-10 exercises during a workout for these muscles.

Frequency of workouts:

It is recommended to do resistance workout 2-3 times a week and the break between exercises for one muscle groups should be at least 48 hours.

Other important things:

  • Start resistance training only after aerobic warm-up routine.
  • Do exercises for big muscle groups first and only then for small muscles.
  • Include in your training exercise focused on multiarticular movement.
  • After the workout, a person should feel moderate fatigue.

Importantly, aerobic training brings more advantages, resistance training should complement but not replace aerobic training.

American Heart Association recommends not only workouts but also regular everyday activities such as walking, climbing the stairs instead of using a lift, home or garden routine. It is also noted that 5-6 hours of general physical activity (including everyday routine) may bring maximum benefits for the health.

The best physical activity to begin with is walking

Walking gives several benefits for patients with heart diseases in comparison with other physical activities at the early stages. Walking helps to improve physical condition and health. Besides, walking is not very intensive aerobic exercise and patients with heart diseases typically cope well with it. Walking does not require buying gym membership or special equipment. All a person needs is a pair of sports shoes.

Risk and warnings

Scientists from the National Heart Foundation in Australia believe that advantages from physical activity outweigh the risks. ACSM specialists say that cardiovascular complications during training develop in 1 case per 100 000 – 300 000 training hours. Their colleagues from Australia state that death of patients associated with heart diseases during training occurs only once per 750 000 training hours. It is important that risks at the absence of physical activity are higher for people with heart diseases.

Specialists share the opinion that risk of relapses as a result of physical activity is higher in people who had a passive lifestyle before and exceed the maximum recommended intensity level during workouts. To reduce risks, patients should start with low intensity trainings and increase it gradually.

Thus, ACSM specialists think that physical activity as means of rehabilitation is safe for patients with stabilized heart diseases. Serious complications occur in very rare cases. Besides, patients who fit regular physical activity into their daily schedule have a lower risk of complications associated with heart diseases.

When you should stop training immediately

In ACSM they state that patients with heart diseases should be informed about 4 key signals warning them about their health condition worsening disregarding the type of their physical activity:

  1. Persistent or periodically occurring angina pain (pain or pressure in the chest, pain in the jaws or neck, discomfort in the hands, pain in the shoulders and back).
  2. Unusually heavy breath, shortness of breath.
  3. Dizziness.
  4. Irregular heart rhythm.

Nausea, excessive sweat, fatigue, pain in the legs and physical tiredness are also the signs to stop trainings according to Australian specialists.

When at least one of these symptoms occur, it is necessary to stop training (slowly decrease its intensity) and consult doctor.

The wrong way to train for people with heart diseases

Too active physical exercises or activity  when intensive periods alternate with sudden breaks make the heart work very hard especially in people who have a passive way of life. For example, shoveling away heavy snow significantly increases heart rate and blood pressure. For this reason, heart attacks occur more often in elderly people who clear snow from pavements and roads.

British scientists recommend people with heart diseases avoid such routines as carrying heavy objects or working hard in the garden, for example trenching the soil. It is also not recommended to participate in competitions such as basketball, football, volleyball, squash etc.

In general, people with heart disease or high blood pressure should avoid intensive physical activity that cause heavy breath or breath-holding and straining. People with heart diseases should also avoid static exercises where the body performs little to no movement while contracting its muscle fibers (for example, plank). People suffering high blood pressure should avoid lifting weights over the head.


If you are taking hypertension medical drugs, then you should avoid sudden changes body posture such as quick standing up from a chair or jumps from lying down to standing position  because it can cause dizziness. You should also spend more time for cooling down because the drugs you are taking can drastically lower your blood pressure if you suddenly end your workout. If your doctor prescribes you a new drug, make sure that it will not affect your physical activity. It is especially true for beta adrenergic blocking agent that decrease heart rate.

Exercise cheat sheet for people with cardiovascular diseases:

  • Never start training without your doctor approve.
  • Increase your physical activity gradually both from the point of view of duration and intensity.
  • Each workout should consist of three blocks: warm-up, exercises and cooling down.
  • Do not do workout after meals, take a break for at least 30 minutes.
  • Make sure that you drink enough water before, during and after workout.
  • Your workout clothing and shoes should be comfortable and fit you well.
  • Do not train when it is too hot, cold or at high altitudes. If you are training in cold and windy weather, wear warmer clothes and don’t forget about a scarf and a beanie.
  • Do not train if you have a viral infection or fever.
  • Stop training if you noticed dangerous symptoms and visit your doctor.
  • Do not take hot shower within first 15 minutes after training, it can provoke increases heart rate and irregular heartbeat.


As you can see, heart diseases should not be a pretext to avoid physical activity. Moreover, people with cardiovascular diseases may improve their health by moving. However, it is critically important to be reasonable and do not overdo. There is no need to chase for records, it does not worth your health and life. Enjoy your workouts, make your heart stronger and live long.

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