How to Exercise After a Heart Attack

Q | I’m recovering from a heart attack and want to start exercising again. What do I need to know?

A | Recovering following a heart attack is a highly individual matter, says Kristina Marcus, MS, cardiac rehab supervisor at Johns Hopkins Medicine. “The damage from a heart attack can be extensive or minimal. You may also be recovering from bypass surgery, or have a stent or other complications at the same time, all of which can affect recovery time. Everyone is different.”

The initial goal for all rehab patients, however, is the same: to restore a baseline of cardiovascular fitness — defined as the capacity to perform 150 minutes of endurance activity per week. That translates into four or five 30- to 45-minute sessions each week. A reasonable goal for many post-heart-attack patients, says Marcus, is to reach that level of fitness after 12 weeks of cardiac rehab.

Rehab usually starts with low-intensity sessions of walking, stationary cycling, and light strength training, sometimes for just a few minutes at a time. To find the appropriate effort level, don’t use the estimated maximum heart-rate formula of 220 minus your age in years. “It doesn’t work well for cardiac patients, who are often taking medications that affect heart rate,” says Marcus.

Instead, monitor your rate of perceived exertion, or RPE, shooting for a level of two or three on a five-point scale. (The table below offers general guidelines, whether you’ve had a cardiac event or not.)

Popular RPE charts also appear with a 0-to-10 and 6-to-20 scale, but don’t worry about the number as much as your effort. Aim to feel like you are working hard — elevated heart rate, heavy breathing — but don’t go to your limit. Avoid pushing to failure, and stop any session immediately if you feel dizzy or exhausted.

There is a simple check to make sure you’re working at the right level: “If you can’t talk while you’re working out, you’re going too hard,” Marcus explains. After your workouts, you may feel tired for an hour or two, but if you’re still tired the day after a session, back off.

Maintaining this low intensity, patients should gradually increase the duration of their workouts about 5 percent a week until they reach the 150-minutes-a-week mark.

“Once you reach that, you can start working on intensity,” says Marcus. Use a steeper incline on the treadmill, more resistance on the stationary bike, and heavier weights.

As long as you keep your intensity in check, Marcus concludes, there’s no reason you can’t hit the gym most days of the week.

Monitor Your Effort