The Dos and Don’ts of Exercising With Heart Failure

When you have heart failure, it’s normal to worry about putting too much pressure on your heart through exercise. Here’s how to work out safely.

If you’ve been diagnosed with congestive heart failure, it means your heart is working harder than it should to pump blood through your body.

It makes sense, then, to wonder if exercise is still safe. After all, our hearts work even harder during a swim or a game of pickleball.

But research shows that a regular exercise routine can help keep heart failure patients out of the hospital. It can reduce your symptoms and even help your heart work better. That’s because physical activity helps strengthen your muscles and improve lung function, taking pressure off your heart.

“People with heart failure think they’ll hurt themselves exercising, but the reverse is true,” says Van Crisco, M.D., a cardiologist and partner at First Coast Heart & Vascular Center based in Jacksonville, Florida.

Exercise also helps maintain muscle mass and bone density, says Dr. Crisco. Because heart failure patients are often at increased risk for falls, he explains, “we want to make sure that you’re prepared for any other health condition that comes at you.”

That doesn’t mean you should throw yourself into a rigorous new exercise program. Some exercises may not be suitable for people with heart failure or certain other heart conditions, reports the American College of Sports Medicine. Here are some rules of thumb to get you started with a fitness routine that works for you and your heart.

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Do: Talk to Your Doctor About Your Exercise Plans

Be sure to check with your cardiologist or primary care physician before starting an exercise program. Some exercises can put too much pressure on your heart. This is especially true for workouts that involve heavy weightlifting or using all your bodyweight, like push-ups and planks.

Your doctor can help you decide which exercises you should do and how often. They can also advise you about how intense your workouts should be.

Don’t: Skip Strength Training

Cardio exercises, like walking, biking, or swimming, can improve your circulation and blood pressure. But you shouldn’t limit yourself to just these activities.

Research shows that strength training (also called resistance training or muscle-strengthening exercise) is safe for heart failure patients when proper precautions are taken. It’s all about knowing which workouts to choose.

Heavy weightlifting can put too much pressure on your heart, but light hand weights are usually a safe option. And there are many resistance exercises that don’t require any equipment, like squats and lunges.

Moderate-intensity resistance training — such as the exercises that make up SilverSneakers Classic group fitness classes — has been shown to boost your ability to function and promote overall good health.

The current U.S. Physical Activity Guidelines call for at least 150 minutes (about 2 and a half hours) a week of moderate-intensity exercise. Adults should also do muscle-strengthening exercises at least twice a week (on non-consecutive days).

Press play to follow along as SilverSneakers LIVE instructor Andi Kwapien demonstrates two bodyweight exercises to build upper- and lower-body strength:

Do: Find Your Exercise Sweet Spot

It’s okay to push yourself when exercising — you want your muscles to be challenged. “But when you get short of breath, stop,” says Dr. Crisco.

Pick moderate-intensity exercises. If you’re unsure whether you’re working out too strenuously, use these guidelines from the American College of Sports Medicine (ACSM). You should:

• Feel comfortable and relaxed when exercising
• Be aware of your breath but not out of breath
• Feel slightly tired and sweaty

Another way to tell you’re at the right intensity? You should be able to lift a weight 10 to 15 times with good form, reports the ACSM. If you can only lift it eight to 10 times before you get tired, the weight is too heavy.

Press play for 5 tips to know when to push yourself — and when to back off:

Don’t: Hold Your Breath or Exercise in the Heat of the Day

Avoid holding your breath when exercising or lifting weights — especially if you have high blood pressure. This can cause large changes in blood pressure, which may increase the risk of passing out. It may even lead you to develop an abnormal heart rhythm.

Another thing to be mindful of? The heat. Exercising in the heat and/or excessive sweating can both stress the heart, says Dr. Crisco.

Do: Join a Cardiac Rehabilitation Program

You don’t have to go it alone. Joining a cardiac rehabilitation program will help shift your mindset and build confidence in your ability to exercise. After a hands-on, physician-supervised assessment, you’ll receive an individualized fitness plan that works for you.

Your cardiologist or health care provider can recommend programs near you. (Cardiac rehabilitation is covered by Medicare for some heart failure patients. Check your health plan benefits for details.) 

Do: Speak Up if You’re Taking a Group Fitness Class 

Good news: SilverSneakers instructors are specially trained in the fitness needs of older adults who are managing different health conditions. If your doctor has given you the green light to attend SilverSneakers classes, let instructors know if you have heart failure (or other condition) so they can suggest modifications.

If you’re joining a SilverSneakers LIVE online class, use the chat function to let the instructor know about your condition. Once class has started, there’s a host who can also answer questions via the chat.

As you work out, know that it’s normal to feel a bit short of breath while exercising. But if you feel excessive shortness of breath, or you’re out of breath while resting, stop and contact your doctor right away.

Chest pain, swelling in your lower body, and worsening dizziness or confusion are also signals that you stop exercising right away and call your doctor.

See our additional sources:
Heart failure overview: American Heart Association
Exercising with heart failure: Cleveland Clinic
Heart failure exercise facts: American College of Sports Medicine
U.S. Physical Activity Guidelines for Americans, 2^nd Edition 

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