When you have
coronary artery disease, it is very important to
exercise regularly. If you aren’t already active, your doctor may want you to
begin an exercise program. Ask your doctor about taking part in a cardiac rehab program. Rehab can help you be more active and make lifestyle changes that can lead to a stronger heart and better health.

Even if you can only do a small amount of exercise,
it is better than not doing any exercise at all.

  • Talk to your doctor before beginning an
    exercise program. Your doctor may do an
    electrocardiogram (ECG or EKG) and possibly an
    exercise stress test to assess how much activity your
    heart can safely handle.
  • After you start exercising, stop your
    activity immediately if you experience angina symptoms (such as chest pain or pressure), feel faint or lightheaded,
    or become extremely out of breath.
  • Start an exercise program, such
    as walking, cycling, or jogging. Try to do
    moderate activity on most, preferably all, days of the week. Aim for a goal to exercise for at least 2½ hours a week.
  • Exercise can help lower the chance of a heart attack.
  • A
    complete exercise program consists of aerobic exercise, strength training, and
  • Set goals you can reach. If you expect too much, you
    are likely to become discouraged and stop exercising.

How can I get started on an exercise program?

Getting started

  • Have a thorough physical exam before
    you begin any exercise program. Your doctor may do an
    electrocardiogram (ECG or EKG) to measure
    the electrical signals that control the rhythm of your heartbeat, and he or she may do
    an exercise stress test to assess what level of activity your heart can
  • Before your appointment, make a list of questions to discuss
    with your doctor. For some general questions, see the
    exercise planning sheet (What is a PDF document?).
  • Make an exercise plan together with your
    doctor. An exercise program usually consists of stretching, activities that
    increase your heart rate (aerobic exercise), and strength training (lifting
    light weights). Visit a library or bookstore for information on exercise
    programs. Join a health club, walking group, or YMCA. Many cities have senior
    centers that offer inexpensive exercise programs.
  • Learn how to find
    the right intensity of exercise. To improve your aerobic power, you don’t need
    to submit yourself to strenuous and uncomfortable exercise. In fact, an
    intensity of exercise called “conversational exercise” (where you can
    comfortably have a conversation while you are exercising) can be very
  • Start out slowly. Try parking farther away from the
    store or walk the mall before shopping. Over time, you will increase your
    ability to do more.
  • Keep a record of your daily exercise. It is
    okay to skip a day occasionally or to cut back on your exercise if you are too
    tired or not feeling well.

How do I measure the intensity of my exercise?

Exercise intensity can be measured in many ways, for example as

  • Rate of perceived exertion
  • Heart rate (HR).

Your doctor can tell you the correct rate of perceived
exertion or how fast your pulse (target heart rate) should be when you

An easy way to check whether you are exercising enough,
but not too much, is to note how hard you are breathing:

  • If you can’t talk and exercise at the same time, you are
    exercising too hard.
  • If you can talk while you exercise, you are
    doing fine.
  • If you can sing while you exercise, you may not be
    exercising hard enough.

How do I calculate my rating of perceived exertion (RPE)?

A rating of perceived exertion, or how hard you think your body is
working, is a fairly accurate way to tell how much strain is put on your body
during exercise.

Using a scale from 6 to 20, you choose a rating number to describe how difficult the activity feels based on how tired you are, how difficult it is to breathe, and how hard it is to do the activity.

It is important that you have a clear understanding of the
perceived exhaustion levels associated with each number. A training intensity
of 13 to 14 (or somewhat hard) would correspond to an exercise HR of
approximately 70% HR max. It is important to use both physiological measurement
such as HR and psychological monitoring such as RPE to get a clear and more
accurate measurement of your overall intensity.

What is my target heart rate?

A target
heart rate can guide you to how hard you should exercise so you can get the
most aerobic benefit from your workout.

Your doctor can help you find out what your target heart rate is. Your target rate may be different from a person who does not have heart disease. This is especially true if you are taking medicine that affects your heart rate, such as beta-blockers,
calcium channel blockers, or digoxin.

You can use your
target heart rate to know how hard to exercise to gain the most aerobic benefit
from your workout. You can exercise within your target heart rate to either
stay at or raise your aerobic fitness level. To raise your fitness level, you
can work harder while exercising, to raise your heart rate toward the upper end
of your target heart rate range. If you have not been exercising regularly, you
may want to start at the lower end of your target heart rate range and
gradually exercise harder.

Target heart rate is only a guide. Each
person is different, so pay attention to how you feel, how hard you are
breathing, how fast your heart is beating, and how much you feel the exertion
in your muscles.

How often should I exercise?

How often you
should exercise depends on several factors. Some exercise programs recommend
exercising a minimum number of days a week. The American Heart Association and
other groups suggest
moderate activity for at least 2½ hours a week. One
way to do this is to be active 30 minutes a day, at least 5 days a
week. It’s fine to be
active in blocks of 10 minutes or more throughout your day and week. The best
number of days for you may depend upon your time availability, your exercise
intensity, the duration of each session, and of course, your overall goals. If
you exercise at a lower intensity level, you may want to exercise more
frequently. Studies have shown that no significant differences in aerobic
capacity are found whether these are consecutive or alternate days. If you are
trying to lose weight, talk to your doctor about how much exercise you

What about duration of exercise?

How long each
exercise session lasts depends on the intensity of the exercise as well as your
objectives. Of course, the higher your exercise intensity, the lower your
exercise duration may be because of fatigue. You should gradually increase the
duration of your exercise as your aerobic power increases. Try to exercise for
at least 10 minutes at a time.

Drink plenty of water before, during, and
after you are active. This is very important when it’s hot out and when you do
intense exercise.

How important is the mode of activity?

If you
hold constant your exercise intensity, frequency, and duration, the mode (type)
of activity you do can improve your aerobic power. You will get the most
improvement from exercises that use the large muscle groups, such as walking,
running, cycling, swimming, or rowing.

Which kind of exercise is best?

As long as you
are exercising large muscle groups, choose an activity that you enjoy. For
example, gardening and dancing can be excellent forms of aerobic exercise.
Enjoying your mode of aerobic exercise will help you stick to your program,
which will help you succeed. Achieving your aerobic goals, losing weight,
increasing your energy, or developing a positive outlook will increase your
enjoyment of the exercise.

Strength training is an important
addition to your aerobic exercise program, because it strengthens and tones your
muscles and increases the blood flow to your working muscles. Many daily
activities and activities on the job require moving, lifting, or controlling a
weight. Maintaining and improving your muscular strength and endurance will help you do
these activities with less stress on your muscles. Increasing your strength
will also increase your
metabolism and energy level.

What type of strength-training exercises should I do?

The keys to a safe and effective strength-training program are function
and balance. Function means that a muscle exercise should be directly related
to its function. For example, the function of your bicep (muscle on the top
front of your arm) is to bend your elbow by moving your lower arm towards your
shoulder. An exercise to strengthen your bicep should therefore reflect the
full range of this motion. Balance is achieved by strengthening complementary
muscle groups (muscles that work opposite each other). For example, your bicep
flexes your arm while your tricep (muscle on the top back of your arm) extends
your arm; while your bicep contracts, your tricep lengthens.

good program should also focus on the major muscle groups of your body,
especially the muscle groups used in your daily life. Strength-training
exercises are described in hundreds of magazines and fitness books and on
television shows and websites.

If you are a beginner, choose
exercises that contain simple motions, emphasize spinal stability, and focus on
specific groups of muscles. Most advertised exercises are beneficial and safe
if you keep control of the weight and use the proper technique throughout
the exercise. Holding your breath while lifting puts extra strain on your
heart, so always exhale when you are lifting any weight.

Working out with
a partner is recommended to keep you safe during your strength training. A
partner can make sure that you are lifting the appropriate amount of weight for
each exercise and can check your form and technique.

What is resistance?

In strength training, resistance is the force that you are
pulling against to work your muscles. A common type of resistance is weight. At
your gym or fitness center, there are probably many different types of
dumbbells and weight machines for you to use. But resistance for
increasing muscle strength and endurance can come from other things besides
weights and weight machines.

Your own body weight, elastic bands,
and wall pulleys can provide effective and progressive strength training. Begin
with a weight that you can easily carry through the required range of motion.
You should only increase the resistance [gradually, or by
5 lb (2.5 kg) to
10 lb (4.5 kg)] when you can
comfortably do the exercises and weights that you’ve been using for a few

If you have angina, heart failure, or other heart
conditions, you may increase the number of times you do each exercise, but
keep the resistance the same. Your movement should be slow and controlled at
all times. If you feel that you cannot control the resistance, decrease the
resistance or lower the weight. Avoid straining, and stop exercising if you
feel symptoms such as dizziness, unusual shortness of breath, or any form of

What are repetitions and sets?

Repetitions are
the number of times you perform each exercise. For example, if you lift a
dumbbell up and down once, that’s 1 repetition (or rep). If you lift it 5
times, that’s 5 reps. Sets are the number of times you do a certain number of
repetitions. For example, if you lift the dumbbell 15 times, take a rest, and
then lift it another 15 times, you have done two sets of 15 reps each.

The number of repetitions and sets you do depends on your
strength-training goals. If you wanted big bulky muscles, you would do a few
sets of a few reps with very heavy weights. But you may want muscular tone
and endurance, which means a few sets of many repetitions with light or medium
weights. A good place to start is with one set of 12 repetitions. You can
gradually work up to 2 or 3 sets of 12 to 15 repetitions.

How can I stretch for flexibility?

Everyone can
benefit from stretching exercises, regardless of age or flexibility. It is
important for you to make stretching a part of your daily exercise routine.
Stretching to increase flexibility should focus on the large muscle groups, and
especially on the muscle groups that affect your posture and mobility.

Before beginning to stretch, warm up your muscles by walking or doing other gentle
movement for a few minutes. You may injure your muscle or tendon if the muscle
is cold and has not been used in a while. You should always stretch in a slow
and controlled manner. Each stretching exercise should be repeated 3 to 5 times
and held for 10 to 30 seconds each time. You should try to gradually increase
your range of motion during each repeated exercise. A feeling of tension is
normal, but do not hold a stretch that is painful.

General guidelines for stretching exercises

  • Stretch before and after
  • Stretch to a position of mild discomfort for 10 to 30
    seconds for each stretch. Try each stretch 3 to 5 times.
  • Control
    and hold without resistance.
  • Be sure to stretch your lower back and your legs.

How can I include exercise in my daily routine?

Remember that even a little exercise is better than none at all. Here are some
tips on building exercise into your daily routine:

  • Get up 15 minutes early and
  • Jog in place.
  • Take a walk at lunchtime or
    after dinner. Use the stairs instead of the elevator.
  • Walk to a
    coworker’s office instead of calling or emailing.
  • Get off the bus
    one or two stops early, and walk the rest of the way.
  • Wash and wax
    your car by hand instead of driving through the car wash.
  • When you
    go shopping, park farther away from the store.
  • Take a brisk walk
    around the mall before you start shopping.
  • Lift light arm weights
    while talking on the phone.
  • Ride a bike.
  • Wash the
    windows. Work in your garden or yard. Use a push mower instead of a riding
  • Walk the dog.
  • Work out to an exercise video.
  • Go dancing.
  • Try to be active as a family, like
    playing tag or catch and taking active vacations.

How can I stay on my exercise program?

Staying on a regular exercise schedule requires discipline and motivation. At
times, it may seem difficult to keep up with regular exercise and physical
activity. But persistence pays off. There are specific steps you can take
to make your exercise program more effective and also to help you stay with

  • Try to make your exercise fun. Do
    activities you enjoy.
  • Set realistic goals. If you expect too
    much, you are likely to become discouraged and stop exercising.
  • Give yourself time. It can take months to get into the habit of exercising.
    After a few months, you may find that you are looking forward to it.
  • Stay with it. It can be hard to stay with an exercise plan. Try
    exercising with a friend-it is much easier to continue an exercise program if
    you are exercising with someone else.
  • Reward yourself. Build in
    rewards along the way that help you continue your program.

What measures should I take to stay healthy while exercising?

When starting an exercise program, keep the following
precautions in mind:

  • Pace yourself by alternating exercises.
    Rotate light workouts, such as short walks, with more strenuous exercises, such
    as low-impact aerobics or swimming.
  • Avoid exercising outdoors in
    extreme temperatures or high humidity or poor air quality. When the weather is
    bad, try exercising indoors at a gym or walking at a mall.
  • Avoid
    exercises that require or encourage holding your breath, such as push-ups,
    sit-ups, and isometric exercises. Also avoid heavy lifting.
  • If you
    develop palpitations, angina symptoms, difficulty breathing, or dizziness or
    lightheadedness, stop exercising and rest. Call your doctor if these symptoms
    don’t go away.
  • Do not take hot or cold showers or sauna baths
    after exercising. Moderate temperatures are best-very hot or very cold
    temperatures can be dangerous.
  • Ask your doctor about continuing
    your exercise program if your medicines change. New medicines can affect how you feel when you exercise.
  • Take your
    pulse frequently or wear a heart rate monitor and keep
    your pulse within the parameters your doctor sets. Watch your pulse when
    walking up hills or stairs.
  • Make sure you adjust your exercise
    program if it is interrupted for more than just a couple of days. Gradually
    increase to your regular activity level as tolerated.


ByHealthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC – Cardiology, Electrophysiology
Kathleen Romito, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Specialist Medical Reviewer E. Gregory Thompson, MD – Internal Medicine

Current as ofOctober 5, 2017