My name is Audree Brookes.
I am a physiotherapist at the Heart Institute.
In this section, we will be talking about physical
activity during your recovery.
The focus will be on the first six weeks after you
return home from the hospital.
If you are following along in your patient guide,
I will be covering pages 29 to 35.
A balance of rest and activity should still be maintained to
allow for continued healing and to conserve your energy.
Activity should be increased gradually.
Everyone's recovery is different.
The rate at which you progress will depend on the severity
of your cardiac event and on your previous activity level.
After four to six weeks, you should be back to performing
your regular activities.
It is recommended that you do regular physical activity as
it will improve the function of your heart and lungs;
improve your HDL cholesterol and triglycerides;
lower your blood pressure;
help you achieve a healthier body weight;
improve your blood sugar;
improve your muscle tone and bone density;
increase your endurance and improve your confidence;
improve your ability to cope with stress;
and decrease anxiety and depression.
Walking is one of the earliest activities you are allowed
to resume and it is one of the best exercises for
improving your health.
Let's review the suggested walking program.
For the first and second week following discharge from the
hospital, we suggest you start with 5-10 minutes of leisurely
walking once or twice a day.
For weeks three to six following your discharge from hospital,
we suggest that you start your walking program with
10 minutes of slow walking.
Increase your walk by one minute per day until you're
walking 20-30 minutes per walk.
Increase your speed and distance as tolerated,
remembering that it is important to avoid
shortness of breath, and fatigue.
Always begin your walk with a slow stroll for the
first 100 feet or so then increase your pace.
Your walking time can be maintained at 30 minutes
once or twice daily.
It is important to start exercising for short periods
of time and at a slow pace.
Gradually increase the length of your walk before
you increase the speed.
If you're having difficulty following the above program,
use interval training.
Interval training consists of walking 2 to 5 minutes,
and then resting for 2 to 5 minutes.
Repeat this pattern as many times as you are able to,
gradually increasing the number of intervals.
After your walk, stretch your calf muscle.
They are likely to get tight as you begin to
increase your daily activity.
The picture on the screen is an example of
someone stretching their calf.
Stand straight and close to a solid surface on which you can
use your hands for balance.
Place one leg behind the other with both feet pointing forward.
Bend the knee that is forward while keeping the
back knee straight until you feel a stretch in
the back of your calf.
Hold for 15 to 30 seconds and then repeat with the other leg.
Next, we will talk about exercise guidelines.
So these are guidelines to follow especially when first
starting an exercise program.
Walk on flat ground initially.
If hills are unavoidable, walk more slowly when going uphill.
It is best to wait about an hour after a meal before you
exercise, as extra energy is required for digestion.
You should be back to your pre-walk or resting state within
10 minutes of completing your exercise.
If not, the next time you exercise,
reduce your time or speed.
If you feel unwell, shorten your walking time.
Go back to the previous level of activity for a few days.
Listen to what your body is telling you.
You may be trying to do too much too soon.
Avoid exercising in extreme temperatures such as hot humid
days or cold, windy ones.
During this time, exercise indoors using stationary
equipment or walk in the hallways of your house or
apartment or in a mall.
If you are using a treadmill, keep it flat.
It is best not to use the incline.
A stationary bicycle can also be very valuable especially if you
have joint problems which may make walking more difficult.
Make sure you peddle at a slow speed with little or no tension.
Avoid exercises where you hold your breath or bear down.
Remember to stop and rest if you:
become very short of breath;
feel weak, tired, lightheaded or dizzy;
have any discomfort, especially chest pain;
have a fast heart rate or palpitations or have
nausea or excessive sweating.
If these symptoms persist, call 911.
In this section, we're going to review self monitoring tools.
So the following tools will help guide you with the progression
of your exercise program.
The first is the walk and talk test.
This is the simplest test of all.
At all times, you should be able to carry on a light
conversation while exercising.
The next one is the rate of perceived
exertion scale or RPE scale.
This is a number based scale used to describe how you feel
during your exercise session.
The number you choose should reflect your overall
level of effort, including your breathing.
There is no right or wrong answer.
For exercise, you should be between
3 and 5 on a scale of 0 to 10.
As your recovery and fitness improve,
so too will your perceived level of effort.
The change in effort you feel overtime,
for the same exercise, is a measure of your improvement.
On pages 32-33 of your patient guide,
you will find an activity log.
We suggest you use this activity log to track your progress.
It can be very motivating as you're working on a walking
program, to track your progress.
We suggest you work on the walking program we
discussed until you start cardiac rehabilitation.
You are strongly encouraged to participate in this program.
Cardiac rehabilitation is a program offering any combination
of exercise, education and counselling with the goal of
helping you learn how to make heart healthy living a
part of your everyday life.
Research demonstrates that people who participate in
cardiac rehabilitation are more successful at managing
their risk factors compared to those who do not.
In most cases, your cardiologist will automatically
refer you to a cardiac rehabilitation program.
If you have not received your appointment while in hospital
or within a few weeks of being discharged from the hospital,
you should contact your doctor and discuss whether
this program is right for you.
Cardiac rehabilitation programs are designed to assist you in
achieving and maintaining a heart healthy lifestyle
and to help you return to everyday life.
There are a number of program options available to residents
living in the Ottawa-Carleton area and surrounding regions.
There is no cost for participation in these programs.
For more detailed information about cardiac rehabilitation,
please refer to pages 57-61 in your patient guide.
In this next section, we will talk about rest
and activity at home.
The following guidelines offer some helpful advice
about activity in general.
First of all, try to get 8 hours of sleep every night
during your recovery period.
Minimize activity after meals, sit and watch television
or read the newspaper.
Stop and rest when you feel tired.
Give yourself enough time for activities so that you
won't feel tense or rushed.
Plan your day to achieve balance between active periods
and quiet times.
Spread out more difficult tasks and alternate an easy
task with a difficult one.
House work is not advised for the first week you are home.
After that, you may resume light house work such as
helping with meals and increase as your tolerance improves.
Standing still for any length of time is very tiring.
During your recovery, sit for as many activities as possible,
for example while washing dishes or preparing food.
Here are some additional guidelines for resuming
activities for daily living.
So for weeks 1 to 3, you can start doing some walking at a
slow pace; writing; drawing; reading; watching television;
knitting; needle work; climbing stairs, slowly; short outings;
lifting 5 to 10 pounds when necessary.
What this means is not lifting more than 5 to 10
pounds for the first 3 weeks.
At week 2, you can start tasks such as laundry; sweeping;
dusting; washing dishes; and preparing light meals.
For weeks 3 to 6, you can start activities such as cleaning
sinks and toilets; mopping the floor; vacuuming; ironing;
bed-making; light gardening; raking leaves;
pushing a light power mower; lifting up to 20 pounds when
necessary; bowling and golfing with the power cart.
Some people may have questions about sexual
activity after a heart attack.
If you have recently had a heart attack,
your doctor might ask you to wait up to 6 weeks before
resuming sexual activity.
From a cardiac stand-point, sexual intercourse is
like any other physical activity, your heart rate
and blood pressure increase.
The activity is compared to walking at 3 to 6
kilometers per hour on a level surface or climbing
20 stairs in 10 seconds.
For more information, please see pages 42-44 in your guide.