How Does Exercise Help Damaged Heart Muscles?

If you’ve had a heart attack or been diagnosed with heart disease, it’s natural to wonder about exercise. Is it safe? Can it help? Or is it too late to exercise for heart health?

“Patients with established heart disease often ask me: Can I return to work? Can I resume sexual activity? Can I exercise? Should I exercise? And the answers to all of those things are, generally, yes,” says Akshay Suvas Desai, MD, MPH, Mass General Brigham cardiologist. Dr. Desai is the medical director of the Center for Advanced Heart Failure/Cardiomyopathy at Brigham and Women’s Hospital, where he cares for patients.

“The long-term benefits of exercise are relevant for patients looking to prevent heart disease and many patients with established heart disease. Just because you’ve already had a heart problem doesn’t mean it’s too late to start,” Dr Desai confirms.

Dr. Desai says exercise can be safe and beneficial for patients with many types of heart conditions, including:

• Coronary artery disease (plaque buildup in the arteries)

• Myocardial infarction (heart attack)

• Heart failure

• Heart muscle disorders related to a prior toxic exposure (chemotherapy, drugs, alcohol), prior heart attack, family history/genetics, or pregnancy

• Heart valve problems

Benefits of exercise with heart disease

Research has not yet found that exercise can reverse heart damage. But it can slow disease progression by improving many of the factors that worsen heart disease. Exercise can help patients with heart disease:

• Combat stress, anxiety, and depression

• Control diabetes and insulin resistance

• Lessen inflammation in the blood vessels and throughout the body

• Lose or maintain body weight

• Lower cholesterol

• Reduce blood pressure

People with heart conditions who exercise are at lower risk for complications, needing care in a hospital, and sudden cardiac death. “What you’re trying to do is stall further cardiovascular injury and improve the body’s ability to manage any existing cardiac injury,” Dr. Desai says.

Exercise also helps people with heart damage function better in everyday life. “It improves your ability to cope with heart dysfunction, because exercise helps your muscles use oxygen more efficiently. Heart function and exercise tolerance get better in people who exercise, which improves your overall ability to live your life,” Dr. Desai adds.

When to start exercising after a heart attack or heart disease

Generally, most people can begin or resume exercise soon after a heart disease diagnosis or cardiac event. This is true as long as you’re comfortable and not limited by your symptoms.

Dr. Desai encourages people to talk with their doctors about starting or resuming an exercise program. “We may not recommend intensive exercise for some patients with cardiovascular disease,” he explains. “But the type of exercise you take on and the way you initiate exercise are things you should discuss with your doctor. They can give you helpful guidance.”

Your primary care provider (PCP) or cardiologist may recommend a clinical stress test or write an exercise “prescription” with detailed suggestions. They may even enroll you in a cardiac rehabilitation program, which has been shown to lead to better outcomes and return to activities.

How to strengthen heart muscle safely with a heart condition

“Many people after a cardiac event ‘find religion,’ so to speak, and are very eager to correct any behaviors they think may have contributed to their heart problems. They tend to start too aggressively,” Dr. Desai says.

On the other hand, he adds, “Others are anxious, so they scale back heavily in order to prevent themselves from doing harm. They tend to over-correct after cardiac events and limit themselves too much. We don’t want patients to view cardiac disease as an excuse not to pursue exercise.”

Instead, he recommends a moderate approach:

• Choose low-intensity or moderate-intensity aerobic activities, such as walking or swimming.

• Start slowly and make your workouts longer and more difficult over time.

• Add light resistance exercises — no heavy strength training.

• Warm up your muscles for a few minutes before you start, then stretch afterward.

• Listen to your body, and rest when you feel the need.

• Exercise safely during different weather conditions, including in the heat and during the winter months.

• Respect any limitations set by your health care providers, and carry any prescribed emergency medications (e.g., nitroglycerin).

• Seek medical attention if you experience symptoms of dizziness, chest pain or pressure, irregular heart rate, extreme shortness of breath, or nausea.

“There is sometimes a perception that exercise needs to be done at a gym at very high intensity,” Dr. Desai says. “But even a modest walking program can have an important cardiovascular benefit — as long as it’s done regularly and for adequate duration, about 20–30 minutes on most days.”