Had a pass surgery or stenting? How can a heart patient get back to exercise?

On December 13, 2018, Dhananjay Yellurkar, then 55, crossed the finish line of the Antarctic Ice Marathon in sub-zero weather. This is a feat attempted very few and completed even fewer. While this was a great achievement in itself, what made it special was the long vertical scar he has across his chest, a reminder of the open heart pass surgery he had in 2009. I remember meeting him the first time in cardiac rehab and telling him that contrary to the gloom he was feeling, life would begin after heart disease and not end because of it. He looked at me sceptically but became a true believer when within a year after his surgery, he ran the half-marathon in Mumbai in January, 2010. Since then, he has gone on to run a full marathon in every continent and is an inspiration for all those living with heart disease.
Before going further, let me stress that one does not “have” to run marathons after heart disease but exercising regularly is a cornerstone of a heart-healthy lifestyle to enjoy good quality of life and reduce the chances of recurrence.
Exercise and heart disease
Exercise has both direct and indirect benefits in reducing heart disease risk. It helps control most modifiable risk factors apart from lowering your blood pressure, diabetes, cholesterol and body weight. Besides these, exercise has a direct effect on the functioning of the heart and allows it to work more efficiently over a longer period of time. With regular exercise, your heart rate at rest is reduced but the amount of blood pumped during each beat actually increases. In simple words, your heart pumps more efficiently. Besides this, regular exercise causes your blood to become “less sticky”, which is beneficial in preventing a clot (thrombus), a major trigger of a heart attack. It also modifies the release of some hormones such as adrenaline and conditions your heart to better deal with emergencies arising out of abnormal heart rhythms.
The exercise prescription
Since “exercise is medicine”, the amount of exercise recommended should be called the exercise prescription. Many patients after a heart attack or surgery are extremely deconditioned. This is a combination of the actual heart ailment as well as the prolonged bed rest that often accompanies it. In addition, the disease tends to have a huge psychological burden, which tends to have physical manifestations. After a cardiac event, the first few weeks should be focussed on gradually getting you back on your feet and ideally should be done in a cardiac rehabilitation programme.
Build it up gradually
The goal is to achieve 30-60 minutes of exercise per day but that does not mean you need to achieve it on day one. In fact, that would be the wrong thing to do. After you have been discharged from the hospital, start with walking for five to 10 minutes, four times a day. Each week, increase the time five to 10 minutes. When you are able to walk 20 minutes at a stretch, you can reduce the frequency to twice a day, and when you reach 30-60 minutes, once a day is good enough. After a heart ailment, you should take you about six weeks to reach this goal. As you achieve this, it is important to add strength training to your routine, for maximum health benefits.
Exercise guidelines for cardiovascular and strength training

Special precautions
While exercising you need to be particularly aware of any symptoms such as angina or shortness of breath. It’s important to remember that any discomfort in the upper part of the body, from navel to nose, which increases with exertion, should be viewed as angina, unless proven otherwise. If you do notice angina, unusual shortness of breath or fatigue with exercise, then you need to stop exercising and seek the advice of your doctor before continuing with exercise. We have all heard the phrase “no pain, no gain”, but this is absolutely not true when it comes to heart disease and exercise.
There is no defined limit to the amount of exercise you can do with heart disease but at the same time, it’s important to discuss your case with your doctor and len to your body. Your programme should include a pre-exercise medical evaluation, graded exercise test and a specific exercise prescription, tailored for you. High-risk individuals need closer supervision and continuous heart rate monitoring. All patients should be encouraged to enrol in a formal cardiac rehabilitation programme. A lifetime of moderate intensity exercise, which is sustainable and enjoyable, will yield the best results in terms of both quality and quantity of life.