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You've just had a heart attack... now what?


Every once in a while, life gives you a second chance. You're handed the opportunity to patch up an old friendship, to correct a problem at work or to fix something that was broken in your life.

If you've survived a heart attack, life has granted you one of the biggest "second chances" you will ever get. How long you continue to live is going to largely be determined by your actions.

Do absolutely nothing, and you can expect to chop 15 years off your life expectancy. However, patients who are aggressive about dealing with controllable causes of heart problems such as obesity, poor diet or inactivity, have the potential to live a full and normal life.

You've got to be aggressive about your treatments and arm yourself with the latest facts to aid in your recovery. After a heart attack or bypass surgery, the American Heart Association (AHA) recommends something called cardiac rehabilitation.

The official definition is:

"...a professionally supervised program to help people recover from heart attacks, heart surgery and percutaneous coronary intervention (PCI) procedures such as stenting and angioplasty. Cardiac rehab programs usually provide education and counseling services to help heart patients increase physical fitness, reduce cardiac symptoms, improve health and reduce the risk of future heart problems, including heart attack."

The simple definition is:

You're going to learn how to drop the bad habits that may have led to your heart attack and replace them with healthy habits.

Aerobic exercises were always considered a vital part of the rehabilitation program, but resistance programs (weight training) were often ignored or even discouraged. There was a belief that lifting weights could cause "myocardial strain." Doctors believed lifting weights increased the risk of aneurysm, arterial dissection or even stroke.

It turns out they were wrong. Researchers found that "myocardial strain" was lower in subjects performing a circuit-based weight training program than during an 85% effort on a treadmill test. Further studies found that people did better when they combined a resistance and aerobic program, than people who just pursued an aerobic program alone.

Because of this new information, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) issued recommendations for resistance training in 2004. The guidelines suggest 3 sets per exercise with 12 - 15 reps per set. The intensity allowed varies from "light" to "somewhat hard" as your strength and health improve.

When can you begin? Resistance training exercises can be started after two weeks of regular participation in cardiac rehab for patients recovering from a transcatheter procedure and four weeks of consistent participation after a myocardial infarction or cardiac surgery. The ultimate goal is to regain the strength needed to return to your normal activities.

To help determine which exercises are best for what patients, the Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, Texas, looked at several exercises and rated them according to safety based on your condition. They evaluated three groups of people.

  1. Those who had a myocardial infarction (heart attack).
  2. Those who had just received a pacemaker or implantable cardioverter-defibrillator (ICD).
  3. Patients who had coronary artery bypass graft surgery (CABG).

The exercises evaluated were as follows: Leg extension, leg curl, standing calf raise, dumbbell bent row, lat pulldown, dumbbell bench press, dumbbell flye, lateral raise, shoulder press, frontal raise, dumbbell curl, tricep kickback and tricep pushdown.

Safe Exercises?

Group a - What they found is that all thirteen weight training exercises were considered "no risk" for patients after a heart attack.

Group b - Patients recovering from a pacemaker or ICD procedure should wait four weeks before attempting a lat pulldown, dumbbell bench press, dumbbell flye, shoulder press or frontal raise.

Group c - Patients who have undergone CABG should wait 6 weeks before attempting a leg curl, lat pulldown, dumbbell bench press, dumbbell flye or frontal raise.

The authors conclude, "Resistance exercise training improves skeletal muscle strength and endurance and is important for the safe return to activities of daily living." They also advocate "changing the guidelines to specify safe exercises rather than specific weights...[because then] exercises could be performed at the level and intensity appropriate to a patient's health and ability."

If you've recently suffered a heart attack, you should look at ways to add resistance training into your recovery program. The safe exercises above are a good place to start.

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CAUTION: Check with your doctor before
beginning any diet or exercise program.