Advantages of Cardiac Rehabilitation for Heart Failure

Cardiac rehabilitation consists of regular exercises incorporating with blood pressure. Plasma glucose and weight control as well as smoke cessation to boost fitness and improve the prognosis objectives of cardiovascular diseases.

There are many advantages of exercise for patients with heart failure. Regular aerobic exercises can improve fitness while the “maximum oxygen uptake” of the body can improve by 15~36% after exercise training. This means that the heart and lungs can deliver more oxygen to the whole body, faster and further, without feeling out of breath. Patients with poor fitness previously will show more progress after exercise training. Aerobic exercises can improve cardiac function and promote the progress of cardiac function indicators (e.g.: cardiac output and left ventricular ejection fraction), as well as improving the collateral blood circulation of cardiac muscle. Other advantages include: improved utilization of oxygen by hand and leg muscle, improving extremity circulation, lowering the activity of sympathetic nervous system, reducing fatigue sensation, and invigorating the depressed and anxious mood.

What are aerobic exercises?

“Aerobic” exercises refer to the intermediate-intensity exercises using the muscle group of the whole body for a certain sustained period (e.g. 12 minutes), including walking, brisk walking, running, riding bicycle, and swimming that can boost the cardiopulmonary and muscle endurance.

As for muscle training (or weight training, resistance exercise), such as lifting dumbbells, lifting heavy objects, and push-ups, these exercises will result in heavier load on the cardiovascular vessels of patients with heart failure. When carrying out the rehabilitation exercise training at the beginning, it is not recommended to go with muscle training but to boost the overall fitness through aerobic exercises. Into few weeks of training, if the patient eventually makes progress in fitness and their cardia response to exercise training is excellent, then patient can then gradually try the muscle training under the guidance and suggestions from the professionals.

How to implement exercise rehabilitation for heart failure.

Inadequate exercise intensity may not meet the purpose of boosting fitness but excessively intense exercise could impose excess burden on the heart with poor conditions and even danger. Hence, it is recommended that patients with heart failure to receive the guidance of professionals for the rehabilitation exercise to maintain safety and effectiveness.

1. The doctors of rehabilitation department and the therapist will explicitly inform you which exercises are suitable and the amount of exercises you need, depending on your special illness condition, in addition to instructing the key to exercises.
2. The doctor will schedule “functional exercise test” if necessary. You will more precisely understand your capacity when engaged in fitness activities through scientific evaluation. Meanwhile, you can record the various symptoms and signs under different intensity of exercise so that the doctor can customer the exercise program for you with ease.

3. When you exercise in the hospital, the professionals and various monitoring instruments will monitor your heard conditions before, during and after your exercise. They will detect early any unstable phenomena with the heart and thereby reduce the likelihood of exercise triggering different complications. Such monitoring will help you clarify the concerns for “if exercise is safe.”
4. When doing exercise training, the professionals will instruct you to perceive the various changes in body during exercise, so that you will eventually learn to control the proper exercise amount at home without the monitoring of instruments or professionals. You will better note the various changes and responses of your body at exercise.
5. Not only will you leave details of exercise records at the department of rehabilitation but you will also be instructed to record the diaries of exercise and changes in symptoms as reference for your doctor of department of cardiology/department of cardiac surgery, who will then be updated with recent conditions of your heart.

Precautions for Low-Intensity Exercises at Home

Follow the doctor and therapist instruction to develop the exercise habits at home. Stay perseverant and the boosting effect of rehabilitation can last longer.  In general, engage in low-intensity exercise at the beginning. The following precautions will help you maintain exercise safety and effectively.

1. Which low-intensity exercises are more suitable?

First, stroll and climb up the stairs easily and slowly (no more than 2 floors of stairs). If you have operative wound on the chest, engage in the shoulder activity instructed by the doctor easily on the non-hurting area. Exercise at least twice a day.

2. How long should the exercise session last?

Do your best. If you can only walk for less than 10 minutes, it is recommended to walk twice a day. The exercise time should be shorter at the beginning (10~20 minutes). Increment the exercise hour eventually to 30~40 minutes. Warm up before the exercise and cool down after exercise (do not rush to stop exercising all at once). You can refer to the following table of “Recommended Exercises for Discharge from the Hospital” and increase the exercise hours by week.

3. How fast should I walk?

In general, do not walk until you feel uncomfortable. The heart rate for the first two weeks should not exceed the “resting heart rate + 20 beats.” After two weeks, you can eventually increase the walking speed but you do not need to walk until your “heart beat becomes heavy.”  

4. What should I feel when walking?

In general, you should walk until “you feel a little tired but not too tired.” You should feel minor sweating, a little bit tired but pleasant and comfortable from exercise. If you feel too tired, out of breath, soaring legs, fatigue, too much sweat, or even chest tightness or dizziness, you will need to slow down the pace or reduce the walking time.

5. Refer to this table for the commended type of exercise, distance and time after discharge from the hospital: 

6. Is it compulsory to meet the walking time and distance of the table?

Not really. You can use this table as a good reference but you don’t have to strive to meet the goals

7.  If I stop because of chest pain or feeling too tired, should I continue after taking a break?

You don’t need to walk until feeling so sick. If this circumstance takes place, you need to slow down or shorten the time until you can continue walking without feeling uncomfortable.

8. How do you know if you are suitable for starting muscle training (or weight training, resistance exercise)?

If during the weeks of exercise training, the doctor and therapist evaluate the progress of your fitness as excellent, you may start with low-resistance under the supervision of professionals.

9. What are other precautions for heart failure?

Follow the suggestions from doctor of department of cardiology/department of cardiac surgery, restrict the water intake to reduce the load on the heart, and pay attention to the “protesting” sound of the heart: If the edema becomes more visible, the weight increases quickly, you feel super tired, out of breath more easily, difficulty with breathing when lying down, and having sleep trouble from constant coughing, these could be symptoms of aggravated heart failure. You are recommended to revisit the hospital early and ask your doctor of department of cardiology/department of cardiac surgery.