1

IntroductionRecovering from a cardiac event may involve

some lifestyle changes.

After any cardiac event (heart attack, surgery,

angioplasty or angina) it can take up to 6-8 weeks

for your heart to recover to a level at which you

are ready to resume all your normal activities.

Your age and how active you were before your

cardiac event, and your psychological reaction to

what has happened will all affect the speed of

recovery. Everyone makes progress at a different

rate.

2

ExerciseExercise can help you to return to a full and

active lifestyle and may help to prevent further

damage to your heart. The best form of

exercise is one that you really enjoy and can fit

into your daily routine.

Exercise has many beneficial effects, such as:

‡ Decreasing blood pressure

‡ Reducing stress

‡ Improving stamina

‡ Controlling blood sugar levels

‡ Lowering cholesterol levels

‡ Helping you loose fat and gain muscle

Over the course of the next few months you

should follow a progressive exercise programme.

This will ensure you get the benefits of exercise

without overdoing it or doing too much too soon.

What type of exercise?You should do something that uses your leg

muscles in steady rhythmic movement - initially

walking is the best thing, or cycling. As you

become fitter you can add other activities such as

exercise classes, dancing, tennis, badminton, golf

and swimming. (If you have had surgery, you

should not swim for three months afterwards.)

3

How long should you exercise?At first, exercise only for short periods: 5-10

minutes, 1-2 times per day. You build up to 30

minutes of exercise on at least 5 days a week.

Always start and finish sessions with warm-up/

cool down exercises. This gives the heart time

to adjust to the altered levels of activity and so

reduces the risk of sudden changes in blood

pressure and abnormal heart rhythms.

How hard should you exercise?In order to benefit, you need to exercise at a pace

that makes you warm and increases your heart

rate and breathing. To help you judge the right

level we use the following scale (which we refer

to as the Borg Scale):

0 nothing at all

1 very light

2 fairly light

3 moderate

4 fairly hard

5 hard

6 hard

7 very hard

8 very tiring

9 very very hard

10 exhausting

Rating your exertionwhilst you are exercising

involves noticing howyour whole body feels, in

particular payingattention to your

breathing - is it slow orfast, do you feel tight inyour chest or struggling

to catch your breath?

4

The programme (i)

WARM-UP / COOL DOWN (LEVELS 1-3)

Do these exercises immediately before and after

your walk. You can do them standing or sitting in

an upright chair. Stand or sit tall, shoulders down

and back and tummy muscles pulled in.

‡ March on the spot for 30 seconds.

‡ Roll shoulders forwards; then up to the

ears; then down & back six times.

‡ Swing alternating arms as if walking briskly.

‡ Repeat whole sequence three times.

MAIN EXERCISE

1 Walking Fairly light / moderate 5 mins 1-2 times daily

2 Walking Fairly light / moderate 10 mins 1-2 times daily

3 Walking Fairly light / moderate 15 mins 1-2 times daily

Now that you can walk at a moderate pace for 15

minutes you may like to add some variety to your

exercise plan. Cycling is excellent for your heart

and can be done instead of walking. As before,

start off slowly with 5-10 minutes, at a pace that

feels fairly light to moderate. Gradually build up.

Level

Exerc

ise

Perc

eiv

ed

exert

ion

Tim

e

Fre

qu

en

cy

5

The programme (ii)

WARM-UP / COOL DOWN (LEVELS 4-6)

At the start of your walk, spend 5 minutes walking

slower than your exercise pace. This prepares

your muscles and heart for the brisker pace. At

the end of your walk, again spend 5 minutes

walking slower than your exercise pace. This

allows your heart and muscles to gently recover.

MAIN EXERCISE

4 Walking Moderate 20 mins 1-2 times daily

5 Walking Moderate 25-30 mins 1-2 times daily

6 Walking Moderate 30-60 mins daily

Once you can walk at a moderate pace for 30-60

minutes, you may like to add dancing, golf, tennis

or badminton to your programme. Stay non-

competitive & keep exertion fairly light /moderate.

Overall, you should be aiming to do 30 minutes of

exercise on five days of the week.

Level

Exerc

ise

Perc

eiv

ed

exert

ion

Tim

e

Fre

qu

en

cy

6

How to use the exercise programmeThe programme has six levels. Begin at a level

you can easily achieve (for most people this will

be at level 1 or 2). You should feel warm, but not

over-heated, and your breathing should be faster,

but not so fast that you feel uncomfortable and

are unable to carry out a conversation.

‡ÿ Stay on this level for as long as it is exerting

you fairly lightly to moderately.

If it feels too hard, drop down a level.

If it feels fairly light to moderate, stay on this level

until it starts to feel very easy or very light, then it

is time to move up to the next level.

‡ Once you reach level 6 of the programme you

are doing just the right amount of exercise to

benefit your heart. Some people reach this level

very quickly, others may take a year or more!

It is important to progress slowly at a pace that

you feel comfortable with.

‡ Some of you will also be joining an exercise

group in the hospital, where we can help you to

choose activities and sports to make your

exercises more varied and enjoyable.

7

Sexual activityMany people with heart disease continue to enjoy

sexual activity. Following a heart attack or

surgery it is usually perfectly safe to resume

sexual activity as soon as you feel ready. Find a

position that suits you and your partner.

Apply the same common sense as with

exercising. As a rough guide, if you can climb up

and down two flights of stairs without discomfort

you are fit enough to resume sexual activity.

If you experience angina or discomfort during

sexual intercourse, it is advisable to stop and

administer GTN spray/tablets if applicable and

wait until you are pain-free before resuming.

Stress and relaxationStress varies for different people but usually

stems from an imbalance between the demands

being made on you & how you think you can cope.

Remember that a certain amount of stress is

normal and healthy. However, too much can

cause harm and trigger a stress response, which

is your body’s attempt to cope with a difficult

situation. You need to find a balance between

life’s demands and your coping resources.

8

Type of stressStress can come from within you (internal) or

from outside (external), for example:

Internal - poor diet, lack of consistency within

work or personal life, unresolved conflicts.

External - noise, pollution, poor working

conditions, bereavement, marriage breakdown.

Fight or flightThe automatic reaction to a threatening situation

is known as the ‘fight or flight’ response. It equips

us to fight or escape from an enemy - or in this

case the difficult situation. Worrying thoughts,

memories or events can turn on adrenaline - part

of nature’s way of helping you cope with danger.

9

Effects of stressEmotional

Anxiety: nervousness

tension

phobias

panic attacks

Depression: sadness

lowered self-esteem

apathy

fatigue

Guilt and shame

Moodiness

Loneliness

Anger

Mental

Difficulty in concentrating

Difficulty in making decisions

Frequent forgetfulness

Increased sensitivity to criticism

Negative self-critical thoughts

Distorted ideas

More rigid attitudes

Physical

Increased heart rate

Increased blood pressure

Difficulty breathing

Muscle contraction / aches

Hot and colds spells

Dilated pupils

Frequent urination

Numbness &tingling sensation

Increased blood glucose levels

10

Effects on health

Coronary heart disease

Hypertension and strokes

Stomach ulcers/nausea/colitis

Migraine/headaches/skin rashes

Diarrhoea

Organisational

Absenteeism

Poor industrial relations

High accident rate

Poor productivity

Job dissatisfaction

Behavioural

Difficulty sleeping

Emotional outbursts/aggression

Excessive eating/loss of appetite

Excessive drinking and smoking

Accident prone

Avoidance of particular situations

Inactivity

11

Why is stress common in people who haveheart problems?Having any kind of heart problem can be a

frightening experience, not only for you but also

for your family. It is natural to be worried even if it

is difficult to put into words exactly why.

People often experience some degree of anxiety

about the possibility of another cardiac event; or

the success of the operation that took place; or

how well they will cope at home.

A cardiac event can be a blow to your self-

confidence, especially if you have not had any

serious health problems before and it is easy to

become depressed. In the first few weeks after

your cardiac event or surgery there are so many

things going on and so much to think about that

depression may not be obvious. Depression can

be experienced in different ways:

‡ Sadness

‡ Loss of enjoyment in hobbies

‡ Loss of interest in sex

‡ Low self-esteem

‡ Poor concentration

‡ Sleeping badly

‡ Lack of appetite

‡ Constant tiredness

‡ Short temper

12

These problems usually settle down if, and when,

the person returns to work and life starts getting

back to normal. It is important to remember that

anxiety and depression is common and often

relieved by help. Discussing your thoughts and

feelings with someone who has gone through the

same experience as you may ease your

problems. Many rehabilitation centres have self-

help groups, which can give long-term support

therapy where it is needed. Also your GP surgery

may offer support and counselling.

RelaxationRelaxation allows mental and physical tension to

be released. The type of relaxation that really

makes a difference in dealing with stress and

tension is regular, daily practice of some form of

deep relaxation. It is a skill that has to be learnt

until it becomes second nature, and is more than

simply sitting down and taking it easy for a few

moments. Some people find using a relaxation

tape helps focus their mind, which enables

relaxation. Find one that suits you, often a

favourite piece of soothing music is all that is

needed to create an atmosphere in which you are

more able to relax – avoid any heavy music with

a regular beat! You may like to make your own

relaxation tape.

13

5 MINUTES OF SIMPLE RELAXATION

This is a simple form of relaxation for occasions

when you only have a short time to spare. It is

more comfortable in a chair with armrests, but it

can be done in an upright chair.

Try to ensure a full five minutes of undisturbed

quiet.

‡ Sit upright & well back in the chair so that your

thighs and back are supported. Rest your hands

lightly on the arms of the chair or in your lap.

‡ Close your eyes gently, settle down

comfortably and begin by breathing, out first then

breathe in, easily and just as much as you need.

Now breathe out slowly with a slight sigh, like a

balloon slowly deflating.

‡ Do this once more very slowly and as you

breathe out feel the tension begin to drain away.

Then go back to your ordinary breathing, even,

quiet and steady.

‡ Now direct your thoughts to each part of your

body in turn, to the muscles and joints.

The order of relaxation is as follows:

‡ Think first about your left foot. Your toes are

relaxed and still. Check up on this because some

people move them when they are tense. Your

foot is resting easily on the floor.

14

‡ Now your right foot/toes/ankles. Next

concentrate on your thighs and legs.

‡ The back muscles relax when the back of a

chair supports your spine.

‡ Let your abdominal muscles become soft and

relaxed. No need to hold the stomach in tightly -

it rises and falls as you breathe quietly.

‡ Now the fingers of the left hand - they should

be curved, limp and quite still. Do the same for

the fingers of the right hand.

‡ Let the feeling of relaxation spread up your

arms to the shoulders. Let your shoulders relax.

Let them drop easily. Feel them relax further

than you thought they could.

‡ Relax your neck muscles.

‡ Let your face relax. Let the expression come

off it. Make sure your teeth are not held tightly

together. Let your jaw relax. This will mean that

your checks and lips are relaxed, as there is no

need to keep up an expression.

‡ Relax your forehead so it feels a little higher

and wider than before.

‡ Now become aware of an all over sensation of

relaxation, of quiet and rest. Feel peaceful,

rested and quiet.

‡ Stay like this, listening to your breathing. Try to

picture a relaxing scene in your mind. Imagine

relaxing music. Keep concentrating on your

breathing and staying relaxed.

15

‡ When your relaxation time is up

- start to wiggle your hands and legs a little,

then open your eyes and sit quietly for a

moment.

- have a stretch, perhaps a yawn, feel

refreshed and alert again!

Choosing an appropriate methodThere are other methods of relaxation, all

beneficial, but very much to individual taste. You

may need to find out if there are any classes near

you.

Alexander technique Music

Deep breathing methods Hobbies

Massage and Aromatherapy Meditation

Physical activity Tai chi Yoga Pilates

These are all general principles, which may help

you after you leave hospital. Remember you can

always seek further advice from your cardiac

rehabilitation team at the Royal Free on 0207 794

0500 ext. 3145, who will be happy to support you

through recovery from your cardiac event.

16

Useful contacts

NHS Direct 0845 4647

Your GP for access to counsellors; or ring the

following direct:

Highgate Counselling Services 020 8883 5427

Hampstead Counselling Service 020 7485 7335

Tavistock Clinic (18-26 years) 020 7447 3742

MIND 020 7272 6797

MIND Crisis 020 7272 7722

Samaritans 020 7734 2800

Some organisations may charge a fee for

counselling sessions.