DID YOU KNOW...
Individuals with Heart Failure
Can Still Benefit from Exercise

By: John Sawdon Director of Education & Special Projects, Cardiac Health Foundation of Canada

What is Heart Failure?

Heart Failure is the name given to a condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood, oxygen and nutrients (1) and results in symptoms of fatigue or shortness of breathe ( dypsnea) on exertion and dypsnea at rest.(2) Because of the lack of oxygen in their brains, organs and muscles, patients with heart failure become tired and breathless. “They may develop fluid retention and become gradually less able to exercise” stated Mariell Jessup Professor of Medicine at the University of Pennsylvania Heart and Vascular Center. These abnormalities in heart function can cause fluid to back up in your lungs and in other parts of your body such as your ankles. The congestion in your lungs and lack of oxygen causes tiredness and shortness of breath. Sometimes the fluid in your lungs can accumulate to the point where it can cause a life-threatening condition called acute pulmonary edema, requiring emergency treatment.(3)

Heart Failure is actually on the rise due to treatment advances whereby individuals now survive heart attacks and other acute heart conditions. The estimate is approximately 600,000 Canadians living with Heart Failure.
Although there is no cure, Heart Failure can be managed very well with lifestyle changes and treatment options. Many individuals with this condition lead full and normal lives.

Potential Causes of Heart Failure

  • Most common is damage to the heart muscle from a heart attack (myocardial Infarction)
  • Second most common cause is Hypertension 75% of those with heart failure ( High Blood pressure)
  • Heart Valves that are not working properly by being too narrow or leaky;
  • Infection causing inflammation of the heart muscle;
  • Excessive use of alcohol
  • Diabetes
  • Being obese or overweight
  • High blood cholesterol
  • Heart muscle disease
  • Other medical conditions including thyroid disease, anemia

Heart Failure and Women (5)

  • Women tend to develop heart failure at an older age than men
  • Women tend to develop diastolic heart failure with a more normal ejection fraction than men. Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart. Heart failure can occur due to a weakened heart muscle. In some cases the ejection fraction can be normal, but due to increased pressures inside the heart and lungs, the person can have heart failure
  • Causes of heart failure for women often linked to high blood pressure, coronary heart disease, valvular disease and diabetes mellitus
  • Although rare, peripartum cardiomyopathy is a cause of heart failure unique to women
  • Depression is frequently associated with heart failure and is more common in women than men
  • Although signs and symptoms are similar for men and women, women tend to have more symptoms of shortness of breath and more difficulty exercising than men. They also experience more swelling on their ankles than men
  • In general women with heart failure survive longer than men http://my.clevelandclinic.org/heart/disorders/heartfailure/hfwomen/causes.aspx

How is Heart Failure Treated?

Controlling cardiovascular risk factors is very important to both prevent and manage heart failure. This includes lowering blood cholesterol, and other fats, lowering blood sugar levels and blood pressure, limiting alcohol intake, stopping smoking and engaging in daily physical activity.
A combination of medication and lifestyle management usually reduces symptoms, improves quality of life, slows the progression of the disease and prolongs life. The Heart and Stroke Foundation of Canada and the BC Heart Failure Network (4) have created an excellent colour coded zone chart that is a great diagnostic tool for individuals with heart failure. This provides suggestions for a daily self monitoring along with asking you to identify the zone you are in that day. If it’s green, your good to go and everything is safe for you. If it’s yellow it’s a warning sign and advises you to go slow that day and to adjust your plans for managing your day. The red zone identifies emergency situations and instructs you to get help by calling 911 immediately. You can download this scale at www.heartandstroke.com/atf/cf/{99452d8b-e7f1-4bd6-a57d-b136ce6c9.

Beneficial effects of Exercise for people with Heart Failure include (6):

  • Improves circulation and helps the body use oxygen better
  • Increases muscle strength and endurance
  • Improves ability to function and undertake activities of daily living
  • Improves quality of life and reduces anxiety and symptoms of depression
  • Improves cardiovascular risk by lowering levels of blood cholesterol, blood sugar and blood pressure
  • Reduces both occurrence and severity of the signs and symptoms associated with heart failure
  • Strengthen the heart and cardiovascular system
  • Strengthen bones
  • Boost self image and self esteem
  • Improves sleep and helps you feel more relaxed and rested, Helps reduce body fat and helps you reach a healthy weight
  • Helps you to look fit and feel healthy

Important Considerations for Heart Failure and Exercise

  • Before starting a program consult with your Doctor. You should ask the following questions:
    1. How much exercise can I do each day?
    2. How often can I exercise each week?
    3. What type of exercise should I do?
    4. What type of activities should I avoid?
    5. Should I take my medication(s) at a certain time around my exercise schedule?
    6. Do I need to take my pulse while exercising?
  • The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines recommends that all patients with stable New York Heart Association(NYHA) class I-III be considered for enrolment in a supervised tailored exercise training program and that a clinical assessment be completed be fore starting an exercise program and that moderate intensity continuous aerobic exercise training( walking, jogging, and cycling) at the Borg rate of 3 to 5 on the ten point scale be the goal (7)
  • People with heart failure need to be stable before starting any exercise program
  • People with heart failure generally have more energy in the morning, particularly midmorning
  • The exercise should be enjoyable to be sustained over the long term, it can include walking to shops, walking your dog or anything that is active and you enjoy
  • You should either attend a cardiac rehabilitation program or access a program with the help of your physician which will assess your aerobic fitness, your heart rate and rhythm, blood pressure, muscle strength and assessment of your endurance level
  • The exercise program should include both aerobic training for heart and lung fitness and resistance exercise training( weight training, but less than 10 lbs)
  • Low blood pressure is a common problem associated with heart failure and exercise, therefore monitoring of blood pressure should occur after session and potentially before. Low blood pressure can cause symptoms of light headedness, fainting, sweating, anxiety, distress, and disturbances in heart rhythm. If these symptoms occur report them to your Doctor
  • People with Heart Failure and Diabetes should monitor and self manage their blood sugar levels before and after exercise
  • Pace yourself and balance your activities with rest
  • Rest when you need to but try not to lay down after exercise, as it reduces exercise tolerance
  • Avoid extreme temperatures if exercising outdoors. High humidity may cause you to become fatigued more quickly, and extreme temperatures can interfere with your circulation, make breathing difficult and possibly cause chest pain. Instead try indoor activities such as mall walking. Also avoid extremely hot or cold showers and sauna baths after your exercise
  • Stop exercising and rest if you experience chest pain, feel weak, are dizzy or lightheaded, have pressure or pain in your chest, neck, arm, jaw or shoulder. If you experience other symptoms that cause you concern stop exercising and see your Doctor
  • Remember start with a warm up that includes stretching, some aerobic exercise to improve the body’s use of oxygen and a cool down phase. The exercise segments could be divided as follows depending on your Doctors recommendation: 5minutes warm up, beginning at ten minutes for aerobics and 5 minutes for cool down. If possible try to achieve a goal of five days a week of least 30 minutes a day
  • Stick with it. If you exercise regularly, it will soon become part of your lifestyle. Make exercise a lifetime commitment. Try to find an exercise buddy as a way to keep you motivated
  • Keep an exercise record as a way tracking your progress
  • Remember your goal will be determined by your Doctors recommendations, your symptoms and you’re agreed upon treatment plan.


References:

  1. Heart Insight Winter 2015 page 20 www.heartinsight.heart.org American Heart Association
  2. CrossMark American Heart Association scientific Statement Exercise and Heart Failure circulation 2003; 107:1210- 1225 circ.ahajurnal.org
  3. Heart Failure, Heart and Stroke Foundation of Canada, www.heartandstroke.com/site/pp.aspx?c=jkIQLcMWJtE&b September 2015
  4. HeartFailureZones-heartandstroke.ca www.heartandstroke.com/atf/cf/{99452d8b-e7f1-4bd6-a57d-b136ce6c9
  5. http://my.clevelandclinic.org/services/heart/disorders/heart-failure-what-is/hic_heartfailure/heartfailureexercise
  6. Chronic Heart Failure and Exercise, Exercise is Medicine Australia Fact sheet May 2014 www.exerciseismedicine.org.au
  7. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on rehabilitation and Exercise and Surgical Coronary Revascularization. Canadian Journal of Cardiology 30 (2014) 249-263 http://dx.doi.org/10.1016/j.cjca.2013.10.010

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advice. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.