My day starts with probably the most important habit I follow as a patient with congestive heart failure. I begin my day with an extended exercise session. (This assumes of course that I have not been experiencing the now very rare bout of overwhelming fatigue). Why do I do this? Because all the websites I see that address congestive heart failure highly encourage patients to exercise. The websites address a variety of types of exercise that are appropriate to perform, but the type that gets the most attention is cardiovascular, also known as aerobic or cardio, exercise.
Why is this? Because according to the Cleveland Clinic website:
Heart failure has not damaged my ability to maintain discipline in my health habits. So I like to start out each day with a commitment to improving my heart health because it seems to me that this is the most critical, upbeat thing I can do to seize some control back from heart failure. We have a small fitness center in my condo building, and my workout doing cardio exercise on an elliptical machine and a treadmill.
You might think that when I finish with the cardio workout, I would hit the showers and be done for the day. But that means you probably have not read enough of these posts, or you would have figured out that I am a work-out-aholic. My Type A habits cause me to add on another session of some core exercises, some Yoga and Pilates moves, some light weights and some resistance training. So what is the conventional wisdom on how this diverse workout impacts my heart?
The American Heart Association website supports the benefits of Yoga. However, it does caution that Yoga does not count towards the recommended physical activity requirements of 150 minutes of moderate intensity aerobic activity per week. Maybe not, but Yoga can still be an intense and ambitious workout. Additionally, with the cardio workout I perform at the beginning of the day, as well as other long walks throughout the day, I much more than meet the 150 minute weekly requirement.
In a previous post, I related how I thought that taking up Yoga, especially Yin Yoga, had provided cardiac benefits that helped me manage my heart failure. So does my sense of health improvement through Yoga have any scientific basis? According to the website Everyday Health, yoga may improve aerobic capacity. This is important because aerobic capacity in turn will jump start your cardio routine.
Why is improved aerobic capacity good? According to the Cleveland Clinic website, researchers from Australia’s University of New England in Armidale, New South Wales, found that heart failure patients who participated in a relatively vigorous exercise regimen had a 23 percent improvement in their heart function. That beat out the 7 percent improvement for patients who participated in less strenuous exercise programs.
Practicing Yoga is associated with improved cardiovascular endurance and quality of life in African-American patients with heart failure, according to a small study published in April 2010 in Medicine and Science in Sports and Exercise. Researchers enrolled 40 patients with heart failure in an at-home exercise program, adding to their usual medical care. Some of the participants also received 16 Yoga therapy sessions over the course of 8 to 10 weeks. At the end of the program, those who included Yoga in their routines had a 22 percent improvement in aerobic capacity. Yoga also led to improved flexibility, decreased heart inflammation, and improved quality-of-life scores.
According to the US News and World Report website, “although it is not proven yet that inflammation directly causes cardiovascular diseases, we know that chronic, low-grade inflammation is closely linked to all stages of atherosclerosis, a disease that underlies heart attack, stroke and peripheral artery disease.” So I figure that any exercise that decreases the risk of this inflammation has to be a good thing.
Yoga is not the only non-cardio exercise that can benefit heart failure patients. My workouts usually include some Pilates moves. Why? Because as the Mayo Clinic website tells us, Pilates isn't just for fitness fanatics. It's actually an accessible way to build strength in your core muscles for better posture, balance and flexibility.
My theory that Pilates benefits heart failure pateitns finds support in a study conducted by Guilherme Veiga Guimarães, MD, of the Universidade de São Paulo in Brazil, reported in Cardiovascular Therapeutics. The study found that Heart Failure patients who underwent training with the Pilates method in combination with 30 minutes of aerobic exercise had greater increases in exercise time, ventilation, and peak oxygen consumption during the 16 week study period compared with those assigned to aerobics and conventional cardiac rehabilitation.
What is the difference between Yoga and Pilates? According to the website of the British Heart Foundation, both develop strength, balance, flexibility, posture and good breathing techniques. But Yoga focuses on finding postures and breathing in them, while Pilates is more about precise movements.
How can improved flexibility help a heart failure patient? First thing, you need to make sure your body is prepped for exercise and prepped for just living without injury. So flexibility moves can be used before and after exercising to prevent injury and strain. Benefits include better balance, range of motion and better movement in your joints.
What are the benefits and precautions for strength training? According to the Cleveland Clinic:
"This type of exercise involves repetitive muscle movement until the muscle becomes tired. Strength training usually involves lifting weights (free weights, weight machines, kettle bells) or using resistance tubes and bands. Benefits are stronger, more toned muscles; stronger bones; weight control (as you build muscle, your body burns more calories); and better balance and posture. Do not use weights heavier than 10 pounds."
I have observed in myself and others that injuries can result from using weight machines, mainly because individuals may not know how to safely and properly use the machine. So my strength training involves only the use of free weights which are fairly straightforward to use. The best thing is I do not have to leave my condo to do these exercises. (And before I forget - with all physical exercises covered in this post, make sure your doctors are okay with the exercise program you decide to adopt.)
In the time that I have been writing these posts, my queries about heart failure would sometimes take me to a site called chfpatient.com. After about the second time that I viewed the site, I realized that it was created by a congestive heart failure patient. I had not come across it in a while but it popped up again when I was doing research for this post.
I found that chfpatient.com has a very detailed page on how important exercise is for heart failure patients, and it described some of the best exercises. The litany of exercises described included those for endurance, those for resistance, strength training and exercises for flexibility. What was most interesting was that there were some pictures of someone performing exercises, and it was the same man in all the pictures.
Who created this site? It was created by someone named “Jon” who said that he became a congestive heart failure patient in 1994. He was diagnosed in 1994 with an ejection fraction of 13 (which is even a little less than mine). He adapted his diet and his exercise regime, and at one point, his ejection fraction returned to 45. (I need to see if he has some advice on his website as to how I can also make that happen!). It appears that for a while Jon’s website for a while was powered by family funds, and maybe even reader donations.
Jon was actively involved in the website until about 2005. Then it appears that his congestive heart failure progressed and Jon became less active. I was wondering if Jon was still alive. I found some comments indicating he died in October 2015. His death was not from heart failure but not other details were provided. His family continues to keep the website up and running because it has become such a vital resource for congestive heart failure patients. According to Jon, the reason he created the website was that Jesus wanted him to do it.
So that leads me to some final observations that are not stated in any health website I found but I think are strongly implied. Your exercise routine needs to also include those of an intellectual nature. Once you finish building up a sweat and challenging your muscles, don’t forget to challenge brain muscles that are often neglected in the couch potato age. Read an intriguing book, do a crossword puzzle, a Sudoku, or a jigsaw puzzle. Play a board game. Or in the case of Jon and me, write a blog or create a website. It doesn’t have to be ambitious – just something that causes you to use the gray cells in your brain.
And on a final note, don’t forget to exercise your spiritual muscles. The stronger your faith is, the easier it will be for you to rise to the challenges of your life, to include unexpected illnesses. You need to keep your heart, mind and soul in good shape so you can give a good one-two punch to the enemies known as disease and despair.
Melanie discovered that she had heart failure in 2013. She spent the next 7 years learning how to live with the condition, and how to achieve balance and personal growth. Then in October 2020, she received a heart transplant. This blog is about her journey of the heart.