Exercise for People with Heart Failure

Overview

The heart is fundamentally a blood pump. It pumps blood from the right side of the heart to the lungs to pick up oxygen. The oxygenated blood returns to the left side of the heart. The left side of the heart then pumps blood into the circulatory system of blood vessels that carry blood throughout the body.

The heart consists of four chambers.

•    The two upper chambers are called atria and the two lower chambers are called ventricles.
•    The right atrium and right ventricle receive blood from the body through the veins and then pump the blood to the lungs.
•    The left atrium and left ventricle receive blood from the lungs and pump it out through the aorta into the arteries, which feed all organs and tissues of the body with oxygenated blood.
•    Because the left ventricle has to pump blood to the entire body, it is a stronger pump than the right ventricle.

Heart failure as a term sounds frightening because it can be misconstrued to mean that the heart just stops working. Heart failure means the tissues of the body are temporarily not receiving as much blood and oxygen as needed. With advancements in diagnosis and therapy for heart failure, patients are feeling better and living longer.

HeartExercise
Figure 1: Heart failure Image courtesy of Bryan Moss at Scott and White Hospital, and David A. Smith, MD.

The heart is a pump that works together with the lungs. The heart pumps blood from the veins through the lungs where oxygen is added and then moves it on to the arteries. This pumping action creates a relatively high pressure in the arteries and a low pressure in the veins. Heart failure is an illness in which the pumping action of the heart becomes less and less powerful. When this happens, blood does not move efficiently through the circulatory system and starts to back up, increasing the pressure in the blood vessels and forcing fluid from the blood vessels into body tissues. Symptoms depend on which area of the body is most involved in the reduced pumping action.

•    When the left side of the heart (left ventricle) starts to fail, fluid collects in the lungs (pulmonary edema). This extra fluid in the lungs (pulmonary congestion) makes it more difficult for the airways to expand as a person inhales. Breathing becomes more difficult and the person may feel short of breath, particularly with activity or when lying down.
•    When the right side of the heart (right ventricle) starts to fail, fluid begins to collect in the feet and lower legs. Puffy leg swelling (edema) is a sign of right heart failure, especially if the edema is pitting edema. With pitting edema, a finger pressed on the swollen leg leaves an imprint. Non-pitting edema is not caused by heart failure.
•    As the right heart failure worsens, the upper legs swell and eventually the abdomen collects fluid (ascites). Weight gain accompanies the fluid retention and is a reliable measure of how much fluid is being retained.

Although heart failure is a serious medical condition, there are many causes and the outcome can vary from person to person. Heart failure may develop gradually over several years, or more quickly after a heart attack or a disease of the heart muscle. Congestive heart failure (CHF) is generally classified as systolic or diastolic heart failure and becomes progressively more common with increasing age. In addition, patients with risk factors for heart disease are more likely to develop congestive heart failure.

Exercise Tips in heart failure

Getting Started
Always check with your doctor first before starting any exercise program. Your doctor will advise you on a program that matches your level of fitness and physical condition. To start the doctor should help you determine and plan;

    How much exercise you can do each day
How often you can exercise each week
What type of exercise you should do
What type of activities you should avoid

When you start:

•    Be sure any exercise is paced and balanced with rest.
•    Avoid isometric exercises, such as pushups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
•    Don’t exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly. Extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities, such as mall walking.
•    Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But be careful not to drink too much water. Follow your doctor’s guidelines about how much fluid you can have in a day.
•    Extremely hot and cold showers or saunas should be avoided after exercise. These extreme temperatures increase the workload on the heart.
•    Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
•    If your exercise program has been interrupted for more than a few days (due to illness, vacation, or bad weather, perhaps), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Exercise Precautions
There are some precautions you must keep in mind when developing an exercise program. Here are some tips.

•    Stop the exercise if you become overly fatigued or develop chest pain. Discuss the symptoms with your doctor, or schedule an appointment for evaluation.
•    Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
•    If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
•    Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it’s still above 100 beats per minute, call the doctor for further instructions.

If you experience pain:
Don’t ignore it. If you have chest pain or pain anywhere else in the body, do not continue the activity. Performing an activity while in pain may stress or damage the joints.

Warning
Stop exercising and call your doctor if you have any of the following symptoms:

•    Chest pain
•    Weakness
•    Dizziness or lightheadedness
•    Unexplained weight gain or swelling
•    Pressure or pain in your chest, neck, arm, jaw, or shoulder
•    Any other symptoms that cause concern

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