Exercise Prescription for Cardiac Patients: A Safe and Effective Plan

Exercise is one of the most powerful tools for managing heart disease, but for individuals with cardiac conditions, it must be done safely and strategically. A well-structured exercise plan can improve heart function, reduce the risk of future cardiac events, and enhance overall quality of life. However, knowing where to start and how to progress safely is key. This article outlines the essential principles of exercise prescription for cardiac patients, providing a deeper understanding of how the heart responds to exercise and how to tailor workouts effectively.

How Exercise Benefits the Heart

Exercise strengthens the heart by improving its ability to pump blood efficiently, reducing the workload on the cardiovascular system. It also:

• Increases stroke volume, meaning the heart pumps more blood per beat.

• Lowers resting heart rate, reducing strain on the heart over time.

• Enhances endothelial function, improving blood vessel flexibility and circulation.

• Reduces blood pressure and cholesterol, key factors in heart disease prevention.

• Improves insulin sensitivity, which helps control blood sugar and reduces diabetes risk.

Types of Exercise for Cardiac Patients

Cardiac patients benefit from a combination of different exercise modalities:

1. Aerobic Exercise (Cardio)

Aerobic exercise strengthens the heart and lungs, improving circulation and endurance. Recommended activities include:

• Walking – A low-impact, accessible option that can be gradually progressed.

• Cycling – Reduces joint strain while providing cardiovascular benefits.

• Swimming – A full-body workout that enhances lung function and circulation; however, if you have heart failure, please consult with your doctor before undergoing hydrotherapy

• Dancing – A fun way to increase heart rate while improving coordination.

Guideline: Start with 10-20 minutes at a low to moderate intensity (RPE 2-4/10) and gradually build to 30-45 minutes, 3-5 days per week.

2. Resistance Training (Strength)

Strength training supports heart health by reducing muscle loss, improving metabolism, and aiding in weight management. Recommended exercises include:

• Bodyweight exercises – Sit-to-stand, wall push-ups, and air squats.

• Resistance bands – Safe and effective for progressive strength development.

• Light weights – Enhances functional strength without excessive strain.

Guideline: Start with 1-2 sets of 8-10 repetitions, focusing on major muscle groups, twice per week, working within an RPE of 3-4/10.

3. Flexibility & Balance Training

Stretching and balance exercises improve mobility, reduce fall risk, and enhance overall function. Recommended activities include:

• Yoga – Aids in relaxation and flexibility.

• Tai Chi – Improves balance and mobility, and reduces stress.

• Active & Static stretching – Helps maintain joint health and range of motion.

Guideline: Stretch each major muscle group for 30 seconds, at least 3 days per week.

How to Determine Safe Exercise Intensity

Exercising at the right intensity is crucial for safety and effectiveness. Here’s how to gauge the appropriate level:

• Heart Rate Monitoring: Target Heart Rate (THR) should be 50-70% of HRmax (Max Heart Rate = 207 - (0.7 x age).

• Rate of Perceived Exertion (RPE): Use the Borg Scale (6-20) or a simpler 1-10 scale, aiming for 10-13/20 or 3-5/10.

• Talk Test: You should be able to carry on a conversation but not sing while exercising.

• Signs to Stop Exercising Immediately:

  • Chest pain or tightness

  • Dizziness or lightheadedness

  • Extreme fatigue or breathlessness

  • Palpitations or irregular heartbeats

• ABSOLUTE Contraindications for Exercising

  • Sternal Instability Scale grade 3 (completely separated)

  • Resting heart rate >120 bpm

  • Severe symptomatic aortic stenosis (blood pressure ≥180/110 mmHg)

  • Recent cardiac event (<2 weeks PCI or <6 weeks if CABG)

  • Patients should not undertake exercise training until they have undergone medical review and have GP and/or surgeon approval.

Sample Beginner Exercise Plan

This structured plan includes a mix of aerobic and resistance exercises tailored for cardiac patients.

Warm-Up (10 minutes)

• Walking with upper-body movements or stationary cycling

• Gentle stretching (shoulders, hamstrings, quadriceps, calves)

Main Session

Exercise	Sets	Reps/Time	Intensity	Rest
Walking	2	5-10 mins	2-3/10 RPE	≤2 min
Sit-to-Stand	2	8-10 reps	2-4/10 RPE	≤2 min
Seated or Standing Row	2	8-10 reps	2-4/10 RPE	≤2 min
Step-Ups	2	4-5 per leg	2-4/10 RPE	≤2 min
Wall Push-Up	2	8-10 reps	2-4/10 RPE	≤2 min

Cool-Down (5-10 minutes)

• Stationary bike or slow-paced walking

• Stretching (hold for 30 seconds per muscle group)

Progressing Safely

Cardiac patients should increase activity levels gradually to avoid overexertion.

• Start with 2 sessions per week, progressing to 2-3 and then 4-5 as tolerated.

• Increase duration before intensity (e.g., adding 2-3 minutes to walks before increasing speed).

• Monitor HR, BP, and symptoms before, during, and after exercise.

• Modify based on medications:

  • Beta-blockers lower heart rate response—meaning, use RPE instead of HR for determining intensity during exercise.

  • Anti-platelets/anticoagulants increase bleeding risk—avoid high-impact activities (initially, 2-4 weeks).

Common Mistakes to Avoid

• Overexertion: Avoid pushing too hard, especially early in recovery.

• Skipping Warm-Up & Cool-Down: Helps prevent arrhythmias and BP fluctuations.

• Ignoring Symptoms: Stop exercise and seek medical attention if unusual symptoms arise.

Call to Action

A well-structured exercise plan can make a huge difference in heart health and overall well-being. If you’re recovering from a cardiac event or managing heart disease, work with an exercise physiologist or join a cardiac rehabilitation program to ensure your plan is safe and effective. Remember, even small steps lead to a healthier heart, helping you Live Younger for Longer!