CARDIAC REHABILITATION HOME EXERCISE ADVICE Introduction Exercise is a very important as part of your rehabilitation and your future health. You will need to exercise at least three times per week, minimum, (ideally 5 - 7 times per week) for you to get any real benefit from the exercise. You should try to build up the amount of exercise you do steadily but gradually. Some of the benefits of exercise for cardiac patients include: ♥ Improved working ability of the heart, both at rest and on exercise ♥ Heart becomes more efficient as a pump ♥ You may be able to do more work before you experience any exercise symptoms, such as angina ♥ Exercise may help to reduce blood pressure both in the short term (during an exercise session it may not increase as much), and in the long term (resting blood pressure may be reduced) ♥ Exercise helps to widen the vessels our blood travels around the body in. If wider, the flow of blood is made easier and so blood pressure is reduced ♥ Exercise may also help to prevent any further development of the fatty plaques which block the blood vessels ♥ Exercise can help to improve the circulation of blood in the heart itself so that the heart muscle gets the oxygen it needs to work efficiently. Types of exercise To gain the benefits mentioned above, and many others that exercise can bring about, cardiac patients should carry out cardiovascular or aerobic exercises. These include walking, cycling, jogging and dancing. Swimming is not recommended as the main form of exercise for cardiac patients but can be included in the overall exercise regime. Please ask for specific advice relating to your condition if you wish to include swimming. You need to build the above exercises into your everyday life in addition to things such as doing the housework, gardening, DIY and other activities such as golf. Exercise such as housework, DIY and golf, etc do not maintain your heart rate for a constant period of time and, although they will help with flexibility and stamina, are not as beneficial for your heart. Cardiovascular/aerobic activities and exercise allow your heart rate to increase steadily and stay elevated for a continuous period of time. Monitoring Exercise Intensity It is important for you to know if you are exercising at the right level for you. There are two ways to ensure you are exercising safely and assess the intensity of exercise. These are: 1. Your Heart Rate 2. The Borg Scale 1 1. Heart Rate (HR) It is important to monitor the heart rate during exercise so you know that your heart is: • working hard enough - otherwise there will be no benefit from the exercise and • not working too hard One of the Cardiac Rehabilitation Nurses can give you your own THR Training Heart Rate Range (THR). This is calculated based on your age and medication. While exercising your heart rate ………………….. should reach between the two figures. If your heart rate (HR) goes above the top figure when exercising, you need to slow down gradually and work at an easier pace. You will be advised about this by one of the Cardiac Rehabilitation Team. How to take your heart rate – this is your pulse a) The Wrist – turn your palm up. Using your index and middle finger (of the other hand), slide your fingers over down the outside of your thumb, over the bulge at its base and onto the wrist. Press gently, gradually increasing the pressure if necessary and feel for a slight bumping against your fingertips. This is your pulse. b) The Neck – place your index finger and middle finger flat across your throat, at the “Adam’s Apple”. Press the fingertips gently inwards and upwards beside the windpipe. The thumping against your fingertips is your pulse. To Count Your Pulse: 1. Find your pulse either at your wrist or neck 2. Look at watch/clock with a second hand on 3. Wait until it reaches the 12 or 6. 4. Start counting the thumps. 5. Count for a) 15 seconds and multiply x 4 b) 30 seconds and multiply x 2 Both of these will give you your heart rate which is always recorded over one minute. 2. The Borg Scale This is a scale used so that you can estimate how much physical effort you use to perform the exercise. As well as considering how hard or easily you are working, you also need to consider the sensations your body is feeling while exercising, i.e., breathing a bit faster, actually feeling your muscles working, feeling warmer and perhaps starting to sweat a bit. Any, or all, of these indicate that you are using increasing physical effort. If you have any other physical problems, eg, a bad knee or hip, you will be using more effort in your exercise because of the problem you have. Your need to include this effort when estimating where you are on the scale Again one of the Cardiac Rehabilitation Nurses can help you understand what level you should aim for. You should never work above 15 on the Borg scale (i.e. feel that the exercise is physically hard). 2 2. The Borg Scale 6 No exertion at all (sitting down) 7 Extremely light / easy Very little / no effort involved (Can keep going ‘all day’) Very light / easy Little effort involved (Can keep going for a very long time) Fairly light / easy Starting to put some effort into it (Can keep going for quite a long time) Somewhat hard Need to put effort into maintaining the speed (Can still keep going for a good period of time) Hard work Really pushing yourself to keep going (Can only keep going for a short time) Very hard work Pushing yourself very hard to keep going (Can only keep going for a very short time) 19 Extremely hard work Pushing yourself extremely hard 20 Maximal exertion 8 9 10 11 12 13 14 15 16 17 18 Preparation for exercise • Warm Up Warming up before any exercise is essential and should be for a minimum of 15 minutes. This allows time for the heart and circulation to adjust so that when your muscles need more oxygen to exercise, it is there. During the warm up your muscles, tendons and ligaments become warmer and your heart rate (pulse) will start to rise. Warm up should start with gentle movement, particularly of the legs which is where we all have the big muscles needing the most oxygen. This movement should become a little more vigorous as the warm up progresses. • Warm Up Exercises 15 minutes (aim for Borg scale 9-10) You need to do a combination of exercises taken from the 3 groups suggested below. Do one minute of each of your selection from groups 1 and 2. Add in the stretches one at-a-time between the other exercises. The stretches should be held for about 10 seconds each. Repeat the exercises one-after-the-other to build your warm up time to the 15 minutes required. 3 1. Pulse raising exercises • Marching on the spot (gentle) - advance to knee lifts (more vigorous) • Heel Digs - add in bicep curls with arms when further into warm up • Side Taps - add in side raise with arms when further into warm up • Backward Toe Taps - add in front raise with arms walking around. 2. Mobilising Exercises The following exercises should be done with marching between each one: • Shoulder rolls with marching – 3 sets (forwards and backwards) • Side bends – 4 right and 4 left (wiggle toes) • Heel toe taps (ankle) 3. Stretches The following stretches should be done with pulse raising exercises (e.g. marching on the spot) in between each one. (Most of these are illustrated at the back of this handout.) • Hamstrings (back of legs) • Calf (lower leg) • Quadriceps / Flamingo stretch (front of upper leg) Upper Back and shoulders • • Chest If not enough time is allowed for the warm up (with a mixture of all the above components) you may be at risk of developing problems during the more vigorous exercise, eg, dizziness, breathlessness, angina and injury to joints and muscles. Please Note: If your main exercise is to be a walk, then the first 15 minutes of the walk (at a slower speed) can be the warm up period. Aerobic or Cardiovascular Exercise/Circuit Training This is the effective part of your exercise session Aerobic or Cardiovascular exercise uses oxygen to help supply the energy that working muscles need. This type of exercise helps to make the heart stronger and you to feel fitter. It is different from some other forms of exercise, such as strength or mobility exercises, which do not use oxygen as effectively. Ideally you should exercise aerobically at least three times per week for 20 to30 minutes. Start with 5 to10 minutes gradually increasing to 30 minutes. Types of aerobic activity are walking, dancing and cycling or circuit training exercises. All of these use repetition of large muscle group activity. There is a selection of different circuit training exercises on pages 8 and 9. Each can be performed for up to 2 minutes to add variety. The exercises offer a selection of different levels of difficulty and should feel fairly hard but not uncomfortable or too strenuous. As someone who had had a heart problem in the past, it is very important that you keep your heart rate (pulse) within the Training Heart-Rate Range when exercising so check your heart rate about 5 minutes into the main exercise part of your session. If you are unable to count your heart rate then you may wish to consider buying a Heart Rate Monitor (choose a simple, inexpensive one). 4 You should also maintain a Borg level of 11 –13, i.e., you are putting some effort into the exercise but it is not becoming ‘hard work’. With any exercise period, whether you are out for a walk or doing another form of exercise, it is essential that you keep moving to make sure your heart rate remains raised. If indoors, do not sit down between exercises or stop moving your feet/toes. The Final Stage Cool Down Cooling down exercise allows blood pressure to return to normal slowly and will prevent dizziness occurring. Heat and waste products are removed from the exercising muscle groups, which reduces the risk of stiffness and aching later on. The cool down should last for at least 10 minutes. It can include:1. Gentle exercises, ie, slow walking – this can be the last 10 minutes of your walk 2. A selection of the pulse raising warm-up exercises done at very slow speed 3. Gentle and slow mobilising exercises from the warm up 4. Stretches from the warm up – holding for 15 – 20 seconds (examples in the back of this handout). At the end of the cool down you should have recovered from the exercise. Your heart rate and breathing rate should have returned to what it was before you started to exercise. What You May Experience While Exercising NORMAL WHILST EXERCISING - KEEP GOING Breathing – faster and deeper STOP EXERCISING IF ANY OF THE FOLLOWING ARE PRESENT Inappropriate levels of breathlessness Feel your muscles working Chest pain or your usual angina pain Heart beating faster Skin will become warm Pulse irregular (unless this is normal for you) Excessive sweating Slightly sweaty Dizziness Feelings of unusual and excessive tiredness Unusual pain, not associated with muscle soreness (can be any where in your body) Please note: Do not exercise if you are feeling unwell. 5 If you are unable to take exercise for several days due to illness, reduce the length of time for your exercise when you start again, and then build it up slowly to your previous level. If your medication is changed it may affect your heart rate – if you notice a difference telephone the Cardiac Rehabilitation Nurses for advice on Barnet Hospital 020 8216 4824 Chase Farm Hospital 020 8375 1887 6 Exercise Reminders 1. Warm up a. 15 minutes b. Begin slowly, gradually increase intensity c. Aerobic forms of exercise e.g. walking, heel digs, lunge backs, side steps, star jumps. d. If it is cold outside and you plan to go out for your exercise walk, warm up inside before you go out. 2. Aerobic Exercise a. 20 – 30 minutes (start with 5-10 minutes and build up) b. Walking is a good form of exercise. Wrap up warmly in cold/rainy weather! You should be walking briskly. c. Cycling, swimming and dancing are also good forms of exercise- try these later on once fully recovered d. Use exercises used in the warm up e.g. heel digs, stepping, side steps combined with walking. e. Stationary bikes are good also if you have your own at home. 3. Cool Down a. 10 minutes b. Slow walking or other gentle exercises to bring your heart rate down c. Hold stretches for at least 15 seconds 4. Monitoring a. You must monitor your heart rate b. During the aerobic exercise it must be within your target heart rate range. It can be measured manually or with a heart rate monitor c. The Borg scale must also be measured 5. Practical Points a. Wear loose clothing b. Do not exercise until 2 hours after a large meal. This can be reduced if the meal is small or a snack. c. Drink plenty of water when you are exercising and afterwards d. If you are diabetic make sure you have a snack available e. Stop exercising immediately if you get chest pain, feel dizzy, uncontrollable sweating f. Do not exercise if you are feeling unwell (e.g. cold, flu) 7 Circuit Training Exercises - (aim for Borg 11 -13) 1) Stepping up onto a Block or Step Level 1 - Tap toes onto step Level 2 - Step up onto Low step Level 3 - Step up on to Higher step Level 4 - High step with bicep curls Level 5 - High step with front raise level 1 - 2 arms level 4 2) Heel digs Level 1 - Heel digs - alternate legs normal pace level 3 Level 2 - Heel digs brisk pace Level 3 - Heel digs normal pace with bicep curls Level 4 - Heel digs brisk pace with bicep curls Level 5 - Heel digs brisk pace with deeper movements 3) Lunge backs Level 1 - Tap alternate feet backwards level 4 Level 2 - Lunge back Level 3 - Lunge back and bicep curls Level 4 - Lunge back with front raise to shoulder height Level 5 - Lunge back with front raise to shoulder height- deeper movements 4) Sit to Stand Level 1 - Hands on chair when rising Level 2 - Hands on thighs when rising Level 3 - Arms across chest Level 4 - Arms across chest- faster pace Level 5 - Arms up in front when rising level 2 5) Star jumps Level 1 - Alternating legs - Side taps level 4 Level 2 - Alternating legs - Side taps - bigger steps Level 3 - As above - with arm raises to waist height Level 4 - As above - with arm raises to shoulder height Level 5 - As above - with arm raises to shoulder height brisker pace 6) Shuttle walking (walking back and forth) Level 1 - Walking normal pace Level 2 - Brisk pace Level 3 - Brisk pace with bicep curls Level 4 - Brisk pace with side/front raises Level 5 - Increased pace from level 4/ jogging 8 level 2 7) Marching on the Spot Level 1 - Normal marching level 3 Level 2 - Bring knees to hands at waist height Level 3 - March with high knees and add bicep curls Level 4 - Same as level 3 but increase pace Level 5 - Jogging on spot Stretches Produced by Cardiac Rehabilitation Team May 2009 – to be reviewed in May 2011 Translations available on the Trust website: www.bcf.nhs.uk. 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