Exercise is an important component of heart failure management, as it can improve cardiovascular function, reduce symptoms, and enhance quality of life. Just about everyone can benefit from moving their body! However, exercise for people with heart failure must be approached with caution, as it can also pose risks if not done properly.
That’s why I really wanted to write an article that will help you incorporate exercise into your life. Back when I was a nutrition intern, I wrote a booklet for the Cooperative Extension program at a local university called “Let’s Get Moving”. I pulled this book out of the archives to write my article!
As a new RD, I interned in cardiac rehabilitation, and I have counseled many people who start exercise programs while seeing me for nutrition. I have literally seen people get out of their wheelchairs. I have also seen people with little fitness train hard to become runners and attend “boot camp” style workouts that last an hour despite a heart failure history.
And if your mobility is limited, this article is for you too! There is an entire section dedicated to exercise with limited mobility complete with a link to a free video I found.
So read on to explore the benefits and risks of exercise with a heart failure diagnosis, as well as guidelines, tips, and examples of an effective program!
Benefits of Exercise for Heart Failure Patients
Let’s start off with the good stuff!
Here are just some of the ways in which exercise can improve cardiovascular function and quality of life:
Improved Heart Function
Exercise can strengthen the heart–remember the heart is a muscle– and improve its ability to pump blood. This speaks for itself, but a stronger heart can decrease fatigue and shortness of breath. And if you feel better, you are better able to do things, take care of yourself and enjoy your life.
Lower Blood Pressure
Exercise can help lower blood pressure, which is an important factor in reducing the risk of heart failure complications. Lower blood pressure means less strain on the heart.
Improved Circulation
Exercise can improve blood flow and circulation, which can help reduce the risk of blood clots and lessen the strain on your heart. Blood flow brings nutrients to your organs and tissues. Good blood flow also helps decrease edema!
Weight Management
Exercise can help heart failure patients manage their weight. While I don’t advocate for extreme or crash dieting, there is no question that carrying extra weight puts a strain on the heart and is an independent risk factor for heart failure.
Improved Mood, Sleep, Cognitive Ability, and Quality of Life
Exercise can improve your mood and overall quality of life. Exercise is also proven to help with anxiety and depression. In addition to endorphins, (“feel-good” hormones released when you exercise) you can’t put a price tag on the feeling of accomplishment and increased self-esteem that comes with exercising.
According to the NIH (National Institute of Health), exercise is related to increased performance in working memory and cognitive flexibility. And, more and more research is emerging that shows exercise is an important factor in preventing dementia. In other words, your brain works better when you exercise!
Risks of Exercise for Heart Failure Patients
While exercise has numerous benefits for heart failure patients, it can pose risks if not done properly. So be careful and keep the following in mind:
Fatigue and Shortness of Breath
Heart failure patients may experience fatigue and shortness of breath during exercise, which can lead to dizziness, lightheadedness, and other symptoms. You can minimize this if you start at a low intensity and gradually increase over time.
Fluid Buildup
Heart failure patients may experience fluid buildup in the lungs or other parts of the body during exercise, which can exacerbate heart failure symptoms. You need to keep an eye on this and weigh yourself daily.
Abnormal Heart Rhythms
Heart failure patients may experience abnormal heart rhythms during exercise, which can increase the risk of heart attack or stroke. It is important to monitor your heart rate during exercise and to stop if any abnormalities are detected or if you feel like something is off.
Dehydration
If you are on a diuretic and/or a fluid restriction, you are at increased risk of dehydration, especially if you sweat a lot. Keep an eye on this, and keep an eye on your urine for signs of dehydration. Be especially mindful in the summer. Your urine should be straw-colored and not dark.
Injury
Heart failure patients may be at increased risk of injury during exercise, due to muscle weakness, balance problems, or other factors. Don’t exercise alone and don’t overdo it.
Guidelines for Safe and Effective Exercise
While there are always some risks, many individuals with heart failure can safely exercise with proper guidance by following these guidelines.
Consult with a Physician
This is so important! Make sure you are okayed for exercise and get specific recommendations. Your physician may want you to start with cardiac rehab first. They may approve you for low intensity exercise only, or they may say you can build up to higher intensities.
Start Slowly!
If you have heart failure, you should absolutely start with low-intensity exercises, like walking, swimming, or cycling at a slow pace, and gradually increase as you are able. You also need to be prepared to monitor yourself for symptoms closely. I recommend an exercise diary, so you can record and reflect on your tolerance.
Monitor Fluid Intake
Monitor your fluid intake and regularly weigh yourself to be sure you are not retaining water. If you are on a fluid restriction, you need to follow it, unless your physician says otherwise. On the other hand, proper hydration is especially important, and you don’t want to get dehydrated. For this reason, pay attention to how much you are sweating and avoid working out in very hot environments. It’s all about balance, isn’t it?
Avoid Extremes in Temperature
If you have heart failure, it’s best to avoid exercising in extreme temperatures, such as during very hot or very cold weather, as this can put additional strain on the heart. I’m not saying to never go outside, as fresh air and a little sunshine are so beneficial! Just avoid the extremes and remember to dress appropriately too!
Use Caution with Strength Training
There is no question that strength training can be beneficial, however, strength training should be done with caution and ideally with the guidance of a professional. This can be as simple as a paper printout from a cardiac rehab expert. You don’t have to hire a personal trainer. Start with light weights and gradually increase as tolerated.
Monitor Heart Rate and Rhythm
If you have heart failure patients, I recommend you monitor your heart rate during exercise using a heart rate monitor or by checking your pulse. Write this in your diary each time you exercise. Ask your physician for heart rate recommendations.
Take Breaks as Needed
Just take a rest if you need it. It sounds simple, but so many people don’t want to do this because they feel like they need to push themselves. Don’t do this. Your fitness will naturally increase over time, and you will be surprised as you improve!
Incorporate Flexibility and Balance Exercises
I’m going to give specific examples in the next section, but incorporating endurance, flexibility, and balance exercises are super important to improve overall health, fitness, range of motion and reduce the risk of falls.
When starting an exercise program, I want you to vary it. And I want you to consider that different types of exercise have different benefits. All are important for different reasons!
Three Types of Exercise
You should incorporate strength, endurance, and mobility into your fitness plan!
Strength Exercise
Strength exercises, involve using weights, resistance bands, or body weight to build muscle strength, muscle mass, and muscle endurance; improving balance, coordination, and bone density.
You can do strength with body weight, traditional weights, or machines if you have access to a gym. You can also use resistance bands. Resistance bands are inexpensive, easy to use, easy to store, and not heavy like weights. Here is a link (I am not sponsored.) https://www.power-systems.com/shop/category/resistance-bands?lastRowID=19
Think about it. Strength will help you avoid falls. And good bone density helps avoid osteoporosis and fractures. You don’t have to go to a gym and throw barbells around. You don’t have to lift gigantic weights. There are lots of ways to build strength. Here are some suggestions.
Squats
Stand with feet shoulder-width apart, bend knees and hips to lower into a squat, then stand up again. Try to use your legs and keep your back straight. This exercise targets the leg muscles, including the quadriceps, hamstrings, and glutes–essentially all of the upper leg. If you need a little support, place one hand on a countertop or sturdy table.
Push-up
Lie face down on the floor, with hands shoulder-width apart and palms on the floor. Push up with your arms until your elbows are straight, then lower back down. You can modify push-ups by getting on your knees, or pushing against the wall from a standing position. Push-ups target the chest, shoulders, and triceps.
Bicep Curls
Hold a weight in each hand and lift towards shoulder, bending at the elbow. Keep your back straight and keep your upper arms next to your body. You can do this seated or standing. This exercise targets the biceps. You can do this with resistance bands too.
Leg Press
If you have access to a gym, sit on a leg press machine and push the weight away with your legs. Start with the lowest weight and use a weight you can press 4-6 times. Work your way up in weight and reps as time goes on. This exercise targets the leg muscles, including the quadriceps, hamstrings, and glutes.
If you are at home, you can do this with resistance bands by sitting on the ground and placing the bands on your feet. Bend your legs, and grasp the bands with your hands. Slowly extend “press” legs forward.
Plank
Lie face down on the floor, then push up onto your forearms and toes, with your body in a straight line. Hold this position for 20 seconds and build up over several weeks to 1 minute or more. Planks target the core muscles, including the abdominals and lower back.
Formal Strength Training Programs
Check with community centers, neighborhood groups, and gyms for a formal strength training program. You can book one or two sessions with a trainer who can help design a safe program for you. I have even known people with heart failure who participate in “boot camp” style classes, cross fit, and TRX. The key is to be open with your trainers, go slowly, and set realistic goals.
Mobility, Stretching, and Balance
This form of exercise involves moving the joints and muscles through their full range of motion. Mobility exercises can improve flexibility, improve balance, reduce the risk of injury, and relieve stiffness and soreness.
Neck Rotations
Sit or stand with your head facing forward, then slowly rotate your head to one side and hold for a few seconds. Repeat on the other side. This exercise targets the neck muscles.
Hip Rotations
Stand up and place one hand on a countertop or sturdy surface for balance. Lift one leg with a bent knee. Rotate your hip in 3-6 forward circles. Then reverse, putting the hip through its full range of motion. Switch sides and repeat.
Shoulder Stretches
Stand with your arms at your sides, then slowly lift your arms up and out to the sides, reaching as far as you can. Hold for a few seconds, then lower back down. Do this again and reach over your head. Alternate 2-3 times.
Toe Touches
Stand with your feet shoulder-width apart, then bend forward and touch your toes. Hold for a few seconds, then slowly stand up again. You can also do this while sitting on the floor or on a pillow with your legs extended in front of you. This exercise targets the back and leg muscles.
Quadricep Stretches
Stand near a wall for support, then lift one foot up behind you and hold it with your hand. You are reaching your heel toward your buttocks. Hold for a few seconds, then release and repeat on the other side.
Seated Spinal Twist
Sit with your legs crossed and your right hand on your left knee. Gently twist your torso to the left, looking over your left shoulder. Hold for a few seconds, then repeat on the other side. This exercise targets the back muscles.
Yoga, Tai Chi and Stretching Programs
Check at your gym, community center, or You Tube. The goal is to increase flexibility, mobility, and balance. This is as important as strength exercises for fall and injury prevention!
Tai Chi is a martial art characterized by slow, deliberate movements and meditation. Many different forms of yoga exist, some more meditative and others more active and fast-paced. Pilates is another great option. In addition, there is an endless variety of stretching and mobility programs available.
There are problems for beginners, advanced and everything in between. Sometimes I search “20 minute stretch” or “30 minute gentle yoga” on You Tube or Google to see what comes up. Here is one to try: https://www.wellandgood.com/20-minute-stretch/
Endurance Exercises
Endurance exercises, also known as aerobic or cardio exercises, raise your heart and breathing rate over a period of time. As you do endurance exercise, your heart efficiency and your fitness improve.
It’s amazing to see how some people improve their endurance in a few short months. I have seen people go from 5 minutes to 50 minutes, so build up slowly!
And check out my article on beets and endurance! The Heart Healthy Benefits of Beets for Heart Failure Patients
Walking
Walking is a low-impact exercise that can be done anywhere and requires no special equipment. Start with short ten minute walks and gradually increase the distance and pace.
Cycling
Cycling can be done indoors on a stationary bike or outdoors on a regular bike. Check out your town greenways. Cycling is a low-impact exercise that can improve cardiovascular fitness and leg strength. Plus it’s fun!
Swimming
Swimming is a low-impact exercise that is easy on the joints and can improve cardiovascular fitness, muscle strength, and flexibility. You can swim laps or simply walk back and forth in the pool. Another option is a water aerobics class. Many cities have indoor community pools that are affordable and heated!
Dance
Dance is a fun and social way to get exercise. It can improve cardiovascular fitness, coordination, and balance. There are adult dance classes, but you can just dance at home to your favorite music.
Jogging or Running
Jogging or running can improve cardiovascular fitness and bone density, but it is important to start slowly and gradually increase intensity to avoid injury.
Activities of Daily Living
Don’t forget about these activities of daily living that absolutely count as exercise!
- Gardening
- Vacuuming, mopping, sweeping, cleaning (not fun but it counts!)
- Taking the stairs instead of the elevator
- Playing with your children or grandchildren
- Park at the far end of the parking lot and walk the entire store when running errands
Exercise for Limited Mobility
If your mobility is limited, you can still do plenty to stay active and healthy. You don’t have to stand up to get fit!
Strength
Try seated leg lifts, seated knee extensions, and seated heel raises. You can do upper body exercises like bicep curls and shoulder presses with either bands or light weights.
Resistance Band Exercises
Resistance bands are inexpensive, easy to use, and can be adjusted to fit any fitness level. Resistance band exercises can be done while sitting or standing and can help target specific muscle groups. Some examples of resistance band exercises include bicep curls, shoulder presses, and leg extensions
Stretches
Chair yoga is a great option, as it combines gentle stretches with deep breathing. Think overhead stretches, gentle twists, toe touches, and neck rotations.
Water Exercises
Water exercises are a low-impact way for people with limited mobility to get a full-body workout. Water provides buoyancy, which reduces stress on the joints and makes it easier to move. Many community pools offer water exercise classes designed specifically for people with limited mobility.
Tai Chi
Tai Chi is a low-impact form of exercise that involves slow, gentle movements and deep breathing. It is particularly beneficial for people with limited mobility as it helps improve balance, flexibility, and mental well-being.
Tai Chi can be practiced either standing or seated and can be adapted to any fitness level. It is often taught in community centers and senior centers, and many instructors offer modified versions for people with limited mobility.
Stretching
Stretching is an important part of any exercise routine and can help improve flexibility, range of motion, and prevent injury. People with limited mobility can benefit from gentle stretching exercises that can be done while seated or lying down.
Examples of stretching exercises include shoulder stretches, neck stretches, and hamstring stretches. Yoga is another great option for people with limited mobility, as it combines stretching with deep breathing and meditation.
Here is a link to a good chair exercise program. (Not sponsored!) https://www.workingonwellnessfoundation.org/
Conclusion
My suggestion is to plan out a week of exercise with at least two days of strength, two days of mobility, and three to four days of endurance. Doing something daily is more beneficial than overloading one day and then not being able to do anything the next. It can be ten minutes a day for the first week or month–whatever you need!
Stay positive and stay accountable!
I hope you enjoyed this article and found it helpful. I would love to hear about what exercises and programs worked for you. Remember that this article is not medical advice and you really need to be cleared by your physician. That being said, I truly believe that exercise is so important for people with heart failure.
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Here are the references I used for this article!
“Exercise Training in Heart Failure: From Theory to Practice” by Marco Guazzi and Piergiuseppe Agostoni. Springer, 2012.
“Exercise Training in Heart Failure: A Review of the Literature” by Emily J. A. Kitzman and Dalane W. Kitzman. Cardiac Failure Review, vol. 6, no. 2, 2020, pp. e12, doi:10.15420/cfr.2020.06.2.e12.
“Exercise-Based Rehabilitation for Heart Failure Patients: A Systematic Review and Meta-Analysis” by Alison E. Thompson, et al. American Journal of Physiology-Heart and Circulatory Physiology, vol. 319, no. 5, 2020, pp. H1050-H1063, doi:10.1152/ajpheart.00066.2020.
“Exercise in Heart Failure: A Review of the Current State of Knowledge” by Federico Moccetti, et al. Heart Failure Reviews, vol. 26, no. 5, 2021, pp. 947-961, doi:10.1007/s10741-021-10063-9.
“Exercise Training in Heart Failure: Mechanisms and Outcomes” by Andrew L. Smith and Dalane W. Kitzman. Heart Failure Clinics, vol. 16, no. 1, 2020, pp. 13-24, doi:10.1016/j.hfc.2019.09.006.
