Exercise for the heart

The ‘best’ cardio workout for a healthy heart

Today is a perfect time to get moving on your fitness goals. Regular exercise does more than help you lose weight and build muscle — although it’s definitely good for those reasons!

Aerobic exercise, also known as “cardio” exercise, uses repetitive contraction of large muscle groups to get your heart beating faster and is the most beneficial type of exercise for your cardiovascular system (your heart and blood vessels). Regular cardio workouts can:

  • Strengthen your heart and blood vessels
  • Improve the flow of oxygen throughout your body
  • Lower your blood pressure and cholesterol
  • Reduce your risk for heart disease, diabetes, Alzheimer’s disease, stroke, and some kinds of cancer

What’s the ‘best’ cardio workout?

My patients often ask me, “What’s the best type of exercise for heart health?” Here’s what I tell them: I don’t care what type of exercise you do as long as you do something!

There is no “magic bullet” for exercise. There’s no “only way” to do it. For example, I’m a cross-trainer. I may work out at the gym for 30 minutes total, but I’ll use three different machines for 10 minutes each to switch it up and keep exercise more interesting for me.

You don’t have to employ the same exercise strategy that I do to get the heart-healthy benefits of cardio exercise. What’s most important is that you exercise regularly. One way you can make that easier is to make it a part of your everyday routine.

We all have a daily routine for personal hygiene — brushing our teeth, taking a shower, and so on. Exercise should be on that list. A lifelong commitment to regular cardio exercise can preserve your heart’s function and keep it “youthful” over the course of your life.

Regular cardio exercise for a healthy heart

I recommend exercising a minimum of four to five days each week. One key part of this schedule is to vary the types and intensity of exercise you do on different days. By changing up your exercise routine regularly, you’ll work different muscles and lower your risk for overuse injuries. You also can avoid the trap of doing the same thing over and over until you get bored and quit altogether.

I recommend moderate-intensity exercise two or three days a week for at least 30 minutes. You should break a sweat and be a little short of breath during good moderate-intensity exercise, but still be able to carry on a conversation.

Take part in a longer activity — at least an hour or more — one day a week as part of your exercise routine. This can be a high-intensity activity such as a Zumba class or a lower-intensity activity such as a long bike ride or a round of golf. The activity itself doesn’t matter as long as you enjoy doing it and it keeps you moving awhile.

If you’re counting, I’ve covered three days of exercise. The fourth day — and fifth if you’re up for a challenge — should include high-intensity training. High-intensity training stimulates different muscles and different responses from your heart and blood vessels than lower-intensity training.

One type of high-intensity training I personally enjoy involves exercising as hard as you can for a short period, resting briefly, and exercising again as hard as you can for another short period (also called high-intensity interval training, or HIIT). There are many types of HIIT. Personally, I like the 4×4. It’s an exercise routine used by the Norwegian ski team, and it involves exercising as hard as you can for four minutes, followed by three minutes of recovery time, for four cycles total.

In addition to cardio training, strength training one or two days each week is good for your heart and overall health. Strength training makes your muscles stronger and also can improve the strength of your bones and metabolism, which can help you avoid diabetes and other conditions.

The order of the days in which you do your moderate-intensity, high-intensity, longer exercise, and strength training isn’t important. You may want to space out the HIIT and strength training to give your muscles a day to recover, avoid injury, and get the most out of your workout time. Weekends or days off work might be a good time to complete your longer workouts.

The heart of the matter

In April 2016, our team completed a two-year, National Institutes of Health-sponsored study looking at how exercise affects participants’ heart health. We studied about 60 middle-aged men and women who had not previously exercised on a regular basis.

Preliminary results of the study suggest that it may be possible to reverse some of the consequences of a sedentary lifestyle if you commit to a heart-healthy exercise routine. We hope to share our full findings soon.

The benefits of a healthy heart for longevity and quality of life are too great to ignore. A regular exercise routine will help you keep your heart healthy for years to come. Jog, swim, golf, hike, play basketball, dance, do yoga — whatever you love to do. The most important thing is to get out there and do it.

Exercise and Cardiovascular Health

Over the past 4 decades, numerous scientific reports have examined the relationships between physical activity, physical fitness, and cardiovascular health. Expert panels, convened by organizations such as the Centers for Disease Control and Prevention (CDC), the American College of Sports Medicine (ACSM), and the American Heart Association (AHA),1–3 along with the 1996 US Surgeon General’s Report on Physical Activity and Health,4 reinforced scientific evidence linking regular physical activity to various measures of cardiovascular health. The prevailing view in these reports is that more active or fit individuals tend to develop less coronary heart disease (CHD) than their sedentary counterparts. If CHD develops in active or fit individuals, it occurs at a later age and tends to be less severe.

As many as 250 000 deaths per year in the United States are attributable to a lack of regular physical activity. In addition, studies that followed large groups of individuals for many years have documented the protective effects of physical activity for a number of noncardiovascular chronic diseases, such as non–insulin-dependent diabetes, hypertension, osteoporosis, and colon cancer.4 In contrast, we see a higher rate of cardiovascular events and a higher death rate in those individuals with low levels of physical fitness.1,4 Even midlife increases in physical activity, through change in occupation or recreational activities, are associated with a decrease in mortality.5 Despite this evidence, however, the vast majority of adults in the United States remains effectively sedentary; less than one-third of Americans meets the minimal recommendations for activity as outlined by the CDC, ACSM, and AHA expert panels.

What Are the Benefits of Exercise?

A sedentary lifestyle is one of the 5 major risk factors (along with high blood pressure, abnormal values for blood lipids, smoking, and obesity) for cardiovascular disease, as outlined by the AHA. Evidence from many scientific studies shows that reducing these risk factors decreases the chance of having a heart attack or experiencing another cardiac event, such as a stroke, and reduces the possibility of needing a coronary revascularization procedure (bypass surgery or coronary angioplasty). Regular exercise has a favorable effect on many of the established risk factors for cardiovascular disease. For example, exercise promotes weight reduction and can help reduce blood pressure. Exercise can reduce “bad” cholesterol levels in the blood (the low-density lipoprotein level), as well as total cholesterol, and can raise the “good” cholesterol (the high-density lipoprotein level ). In diabetic patients, regular activity favorably affects the body’s ability to use insulin to control glucose levels in the blood. Although the effect of an exercise program on any single risk factor may generally be small, the effect of continued, moderate exercise on overall cardiovascular risk, when combined with other lifestyle modifications (such as proper nutrition, smoking cessation,and medication use), can be dramatic.

Benefits of Regular Exercise on Cardiovascular Risk Factors

  • Increase in exercise tolerance

  • Reduction in body weight

  • Reduction in blood pressure

  • Reduction in bad (LDL and total) cholesterol

  • Increase in good (HDL) cholesterol

  • Increase in insulin sensitivity

There are a number of physiological benefits of exercise; 2 examples are improvements in muscular function and strength and improvement in the body’s ability to take in and use oxygen (maximal oxygen consumption or aerobic capacity). As one’s ability to transport and use oxygen improves, regular daily activities can be performed with less fatigue. This is particularly important for patients with cardiovascular disease, whose exercise capacity is typically lower than that of healthy individuals. There is also evidence that exercise training improves the capacity of the blood vessels to dilate in response to exercise or hormones, consistent with better vascular wall function and an improved ability to provide oxygen to the muscles during exercise. Studies measuring muscular strength and flexibility before and after exercise programs suggest that there are improvements in bone health and ability to perform daily activities, as well as a lower likelihood of developing back pain and of disability, particularly in older age groups.

Patients with newly diagnosed heart disease who participate in an exercise program report an earlier return to work and improvements in other measures of quality of life, such as more self-confidence, lower stress, and less anxiety. Importantly, by combining controlled studies, researchers have found that for heart attack patients who participated in a formal exercise program, the death rate is reduced by 20% to 25%. This is strong evidence in support of physical activity for patients with heart disease. Although the benefits of exercise are unquestionable, it should be noted that exercise programs alone for patients with heart disease have not convincingly shown improvement in the heart’s pumping ability or the diameter of the coronary vessels that supply oxygen to the heart muscle.

How Much Exercise Is Enough?

In 1996, the release of the Surgeon General’s Report on Physical Activity and Health provided a springboard for the largest government effort to date to promote physical activity among Americans. This historic turning point redefined exercise as a key component to health promotion and disease prevention, and on the basis of this report, the Federal government mounted a multi-year educational campaign. The Surgeon General’s Report, a joint CDC/ACSM consensus statement, and a National Institutes of Health report agreed that the benefits mentioned above will generally occur by engaging in at least 30 minutes of modest activity on most, preferably all, days of the week. Modest activity is defined as any activity that is similar in intensity to brisk walking at a rate of about 3 to 4 miles per hour. These activities can include any other form of occupational or recreational activity that is dynamic in nature and of similar intensity, such as cycling, yard work, and swimming. This amount of exercise equates to approximately five to seven 30-minute sessions per week at an intensity equivalent to 3 to 6 METs (multiples of the resting metabolic rate), or approximately 600 to 1200 calories expended per week.

Note that the specific phrase “…30 minutes of accumulated activity…” is used in the above-mentioned reports. It has been shown that repeated intermittent or shorter bouts of activity (such as 10 minutes) that include occupational and recreational activity or the tasks of daily living have similar cardiovascular and other health benefits if performed at the moderate intensity level with an accumulated duration of at least 30 minutes per day. People who already meet these standards will receive additional benefits from more vigorous activity.

Many of the studies documenting the benefits of exercise typically use programs consisting of 30 to 60 minutes of continuous exercise 3 days per week at an intensity corresponding to 60% to 75% of the individual’s heart rate reserve. It is not usually necessary, however, for healthy adults to measure heart rate diligently because substantial health benefits can occur through modest levels of daily activity, irrespective of the specific exercise intensity. In fact, researchers estimate that as much as a 30% to 40% reduction in cardiovascular events is possible if most Americans were simply to meet the government recommendations for activity.

Recommendation for Physical Activity From the CDC/ACSM Consensus Statement and Surgeon General’s Report

Every American adult should participate in 30 minutes or more of moderate intensity activity on most, and preferably all, days of the week.

  • Moderate activities: activities comparable to walking briskly at about 3 to 4 miles per hour; may include wide variety of occupational or recreational activities, including yard work, household tasks, cycling, swimming, etc.

  • Thirty minutes of moderate activity daily equates to 600 to 1200 calories of energy expended per week.

Physical Fitness and Mortality

One need not be a marathon runner or an elite athlete to derive significant benefits from physical activity. In fact, the Surgeon General’s physical activity recommendations seem surprisingly modest. One reason for this is that the greatest gains in terms of mortality are achieved when an individual goes from being sedentary to becoming moderately active. Studies show that less is gained when an individual goes from being moderately active to very active. In a study performed among US veterans, subjects were classified into 5 categories according to fitness level. The largest gains in terms of mortality were achieved between the lowest fitness group and the next lowest fitness group. The researchers studied 6213 men over a 6-year period and compared the risks of death (after allowing for age adjustment) by gradients of physical fitness.6 The Figure shows the relative risks associated with the different categories (1 to 5, lowest to highest) of fitness measured. Healthy adults who are the least fit have a mortality risk that is 4.5 times that of the most fit. Surprisingly, an individual’s fitness level was a more important predictor of death than established risk factors such as smoking, high blood pressure, high cholesterol, and diabetes. This study, along with others, underscores the fact that fitness and daily activity levels have a strong influence on the incidence of heart disease and overall mortality.

Age-adjusted mortality rates in healthy men categorized by level of fitness. The range of values for exercise capacity (METs) for each category are represented within each bar (modified from reference 6).

What Are the Risks of Exercise?

During exercise, there is a transient increase in the risk of having a cardiac-related complication (for example, a heart attack or serious heart rhythm disorder). However, this risk is extremely small. For adults without existing heart disease, the risk of a cardiac event or complication ranges between 1 in 400 000–800 000 hours of exercise. For patients with existing heart disease, an event can occur an average of once in 62 000 hours.2,3 Importantly, the risk of a cardiac event is significantly lower among regular exercisers. Evidence suggests that a sedentary person’s risk is nearly 50 times higher than the risk for a person who exercises about 5 times per week. Stated simply, individuals who exercise regularly are much less likely to experience a problem during exercise. Moreover, contrary to popular view, the majority of heart attacks (approximately 90%) occur in the resting state, not during physical activity.

Exercise is therefore considered to be extremely safe. Nevertheless, it is a good idea to be aware of the warning signs or symptoms that may indicate a problem: chest discomfort (pain or pressure in the chest, jaw, or neck, possibly radiating into the shoulder, arm, or back), unusual shortness of breath, dizziness or light-headedness, and heart rhythm abnormalities (sensations of heart beat skipping, palpitations, or thumping). If one of these symptoms occurs, medical attention should be sought immediately (see also Cardiology Patient Page by Ornato JP, Hand MM. Warning signs of a heart attack. Circulation. 2001;104:1212-1213).

How Should You Begin if You Want to Become More Physically Active?

First, if you currently have heart disease or are over 45 years of age and have 2 or more risk factors (immediate family member with heart disease before age 55, cigarette smoking, high blood pressure, abnormal cholesterol levels, diabetes, sedentary lifestyle, or obesity), you should consult your physician before starting any type of exercise.2 Clearly, most people can derive significant benefits from integrating a half hour of moderate activity into their day. If you know you simply cannot or will not set aside a half hour of activity on a given day, then try to work more activities into the day by taking the stairs rather than the elevator, or try walking rather than driving a short distance to the store. Try to work several shorter periods of activity, such as 10 minutes, into your schedule. The most important thing is to get started. There is mounting evidence in the scientific literature that physical activity and physical fitness have a powerful influence on a host of chronic diseases, a fact underscored by the recent Surgeon General’s report on Physical Activity and Health.4 Reducing the risk of heart disease through greater physical activity could have an enormous impact on health in the United States.

Estimation of Exercise Intensity Using Heart Rate Reserve

*Although maximal heart rate range is commonly determined by a formula such as 220-age, such estimates are not very accurate; maximal heart rate can only be determined accurately from a maximal exercise test.
†Desired exercise intensity is usually 60% to 80%.
(Maximal heart rate* − resting heart rate) × desired exercise intensity† + resting heart rate
            Example:
Maximal heart rate = 150 beats/min
− Resting heart rate = 70 beats/min
= 80 beats/min
× Desired intensity = 60% (0.60)
= 48 beats/min
+ Resting heart rate = 70 beats/min
= Training heart rate 118 beats/min
A reasonable training heart rate for this individual would be 115 to 120 beats/min

*One MET is the amount of energy required at rest, equal to approximately 70 calories per hour; 3 METs represents an exercise intensity equivalent to 3 times the metabolic rate at rest.

Footnotes

Correspondence to Jonathan Myers, PhD, Cardiology 111-C, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304. E-mail

  • 1 Pate RR, Pratt MP, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA,. 1995; 273: 402–407.CrossrefMedlineGoogle Scholar
  • 2 American College of Sports Medicine. Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2000.Google Scholar
  • 3 Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104: 1694–1740.CrossrefMedlineGoogle Scholar
  • 4 US Public Health Service, Office of the Surgeon General. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.Google Scholar
  • 5 Paffenbarger RS, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Eng J Med. 1993; 328: 538–545.CrossrefMedlineGoogle Scholar
  • 6 Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346: 793–801.CrossrefMedlineGoogle Scholar

Diet and Exercise for a Healthy Heart

Your heart is the center of your cardiovascular system. It is involved in many of the daily functions that bring your body to life. So having a healthy heart is vital to your overall health. Two of the simplest yet most important ways to help your heart health are through diet and exercise.

Path to improved health

How does what I eat affect my heart?

The foods you eat can affect your weight, your hormones, and the health of your organs, including your heart. Eating a healthy diet can help reduce the risk of heart disease and stroke.

Keeping your heart healthy by making healthier food choices isn’t as hard as it sounds! Just follow these tips for a heart-healthy diet.

  • Choose healthy fats. Despite what you may have heard, some fats are actually good for you. When you use fats for cooking, choose monounsaturated fats, such as olive oil or canola oil. Avocados are also a good source of monounsaturated fat. Polyunsaturated fats and omega-3 fatty acids are also healthy choices. Polyunsaturated fats are found in nuts and seeds. Omega-3 fats are found in fish such as tuna and salmon. In general, you should try to avoid trans fats. Trans fats are usually found in processed foods and snacks such as crackers or snack cakes. To see whether a food contains trans fats, look for the words “partially hydrogenated” in the ingredient label.
  • Go whole-grain. Whole-grain breads or pastas are higher in fiber and complex carbohydrates. Choose them instead of white breads or regular pastas for sandwiches and meals.
  • Eat plenty of fruits and vegetables. They contain fiber, vitamins and minerals that are good for your body. They also add flavor and variety to your diet.
  • Prepare meat healthfully. Baking, broiling and roasting are the healthiest ways to prepare meat and poultry. Trim any outside fat or skin before cooking. Lean cuts can be pan-broiled or stir-fried.
  • Don’t forget beans. Dry beans, peas, and lentils offer protein and fiber. Once in a while, try substituting beans for meat in a favorite recipe, such as lasagna or chili.
  • Choose low-fat dairy. Go for fat-free or low-fat versions of milk, yogurt, and cheese products. Eat no more than 4 egg yolks a week (use egg whites or egg substitutes).
  • Pack in protein. Eat protein–rich foods, including fish, lean meats, skinless poultry, eggs, nuts and seeds, and beans.
  • Try a diet. The DASH eating plan is a heart-healthy approach that lowers blood pressure and bad cholesterol in your blood. Or try the Mediterranean Dietfor one of the healthiest approaches to eating we know about.

What should I NOT eat?

A heart-healthy diet limits some nutrients. These include:

Sodium. Flavor foods with spices or no-salt seasonings instead of salt. Watch out for prepackaged foods, sauces, canned foods, and processed foods. They can all contain a high amount of sodium.

Saturated and trans fats. Saturated fats are found in fatty meats, poultry skin, whole-milk dairy, butter, lard, and coconut and palm oils. Tans fats are found in some desserts, microwave popcorn, frozen pizza, stick margarines, and coffee creamers. Look for the words partially hydrogenated oil on the food label.

Added sugar. Sweetened drinks, snacks, and sweet treats are the main source of added sugars in the United States. These include sodas, sweetened coffee and tea, energy drinks, cakes, pies, ice cream, candy, syrups, and jellies. Limit these types of foods and drinks.

Alcohol. Limit your intake of alcohol. Men should have no more than 2 drinks a day. Women should have no more than 1 drink per day. Too much alcohol can raise your blood pressure and cause you to gain weight. It can also contribute to or worsen heart failure in some people.

How much should I weigh?

Talk to your family doctor about your ideal weight, because every person is different. If you’re overweight, the extra pounds put extra stress on your heart. Losing weight can help your heart stay healthy. Remember that losing just 10% of your body weight will reduce your risks for diabetes and heart disease.

Exercise

Exercise makes your heart stronger. This helps it pump more blood with each heartbeat. This delivers more oxygen to your body. With more oxygen, your body functions more efficiently.

Exercise can also lower blood pressure. It reduces your risk of heart disease and reduces levels of LDL (“bad” cholesterol). Bad cholesterol can clog the arteries and can cause a heart attack. At the same time, exercise can raise levels of HDL (“good” cholesterol). HDL helps protect against a heart attack by carrying fatty deposits out of the arteries.

When combined with a healthy diet, exercise can speed up weight loss. Regular exercise builds lean muscle, which burns more calories than fat. This helps you burn calories faster, even when you’re sitting still.

What’s the best type of exercise for my heart?

Aerobic exercise causes you to breathe more deeply. It makes your heart work harder to pump blood. Aerobic exercise also raises your heart rate (which burns calories). Examples of aerobic exercise include walking, jogging, running, dancing, swimming, and bicycling.

How much exercise do I need?

If you haven’t been exercising, try to work up to 30 minutes, 4 to 6 times a week. Your doctor may recommend a different exercise regimen based on your health. Alternate exercise days with rest days or days you do a very different type of exercise. This will help prevent injuries.

How will I fit exercise into my busy schedule?

There are lots of ways to raise your heart rate during your regular day. Some examples include:

  • Take the stairs instead of the elevator.
  • Walk during a coffee break or lunch.
  • Walk to work, or park at the end of the parking lot so you have to walk farther.
  • Walk more briskly.
  • Do housework at a quicker pace and more often (for example, vacuuming every day).
  • Rake leaves, mow your lawn, or do other yard work.

Things to consider

Diet and exercise are an important part of your heart health. If you don’t eat a good diet and you don’t exercise, you are at increased risk of developing health problems. These include high blood pressure, high cholesterol, obesity, type 2 diabetes, and heart disease. These increase your risk of heart attack and stroke.

Questions to ask your doctor

  • Should I eat a special diet to keep my heart healthy?
  • What types of foods should I eat?
  • I am overweight. How can I lose weight to make my heart healthier?
  • How does exercise help my heart?
  • How much should I exercise?

Resources

National Heart, Lung, and Blood Institute, Heart-Healthy Lifestyle Changes

Being active when you have heart disease

Your provider will tell you what exercise is best for you. Talk with your provider before you start a new exercise program. Also ask if it is OK before you do a harder activity.

Aerobic activity uses your heart and lungs for a long period of time. It also helps your heart use oxygen better and improves blood flow. You want to make your heart work a little harder every time, but not too hard.

Start slowly. Choose an aerobic activity such as walking, swimming, light jogging, or biking. Do this at least 3 to 4 times a week.

Always do 5 minutes of stretching or moving around to warm up your muscles and heart before exercising. Allow time to cool down after you exercise. Do the same activity but at a slower pace.

Take rest periods before you get too tired. If you feel tired or have any heart symptoms, stop. Wear comfortable clothing for the exercise you are doing.

During hot weather, exercise in the morning or evening. Be careful not to wear too many layers of clothes. You can also go to an indoor shopping mall to walk.

When it is cold, cover your nose and mouth when exercising outside. Go to an indoor shopping mall if it is too cold or snowy to exercise outside. Ask your provider if it is OK for you to exercise when it is below freezing.

Resistance weight training may improve your strength and help your muscles work together better. This can make it easier to do daily activities. These exercises are good for you. But keep in mind they do not help your heart like aerobic exercise does.

Check out your weight-training routine with your provider first. Go easy, and do not strain too hard. It is better to do lighter sets of exercise when you have heart disease than to work out too hard.

You may need advice from a physical therapist or trainer. Either one can show you how to do exercises the right way. Make sure you breathe steadily and switch between upper and lower body work. Rest often.

You may be eligible for a formal cardiac rehabilitation program. Ask your provider if you can have a referral.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *