When you have congestive heart failure, your heart is unable to function regularly. You may frequently feel short of breath or tired. You may also have some chest pain or swelling in the ankles.

If you’ve been diagnosed with heart failure, your doctor may recommend participating in cardiac rehabilitation (rehab).

This article will detail how and why cardiac rehab can help your quality of life when you have heart failure. Be sure to consult a doctor before you start exercising, especially if you’ve been diagnosed with heart failure, to make sure you can work out safely.

When you have heart failure, it’s not always possible to reverse the damage to your heart.

However, you can try to reduce your risk factors for worsening heart failure while also enhancing your quality of life. These are the goals for an exercise-based cardiac rehab program, along with reducing mortality or risks for death.

If you are able to make healthy lifestyle changes as a result of cardiac rehabilitation, you can improve your heart health. Engaging in regular exercise as part of a cardiac rehab program can further help your body respond to exercise.

Exercise can have the following effects:

  • You can improve muscle strength and flexibility. Your body is better able to respond to physical demands, such as lifting or moving, without having to use the heart more.
  • Your lung function can improve, which helps to reduce demands on your heart, according to 2018 research.
  • You can relieve stress and anxiety, which places less stress on the heart and mind.
  • You may feel less fatigued, which can enhance your quality of life.
  • You may extend your life. Research from 2021 found that patients with heart failure who participated in cardiac rehab exercise programs experienced a 35 percent reduction in mortality over a period of 2 years.

Not everyone who participates in cardiac rehab will experience all of these benefits. It often depends on how significant your heart failure and lifestyle changes are. Those with severe heart failure may have a more difficult time tolerating exercise.

What is cardiac rehabilitation like?

Cardiac rehab usually includes several factors, such as:

  • Exercise counseling. You’ll receive information on how to exercise safely with heart failure, including signs you’re overworking your heart or can work harder.
  • Risk factor counseling. Some lifestyle factors increase your risk for heart failure worsening. These include smoking, excess alcohol consumption, and poor nutritional choices. Cardiac rehab includes information on how to minimize your risk factors to improve your health.
  • Stress reduction counseling. Stress is another aspect that can have ill effects on your heart. Cardiac rehabilitation focuses on stress reduction techniques to help you live better with heart failure.

Both the American Heart Association (AHA) and the American College of Cardiology recommend cardiac rehab as a class I recommendation for heart failure treatment, according to the 2021 research mentioned earlier.

Class I recommendations are those that have been well-researched and proven likely to be beneficial.

However, there are times when a person with heart failure should not participate in cardiac rehab since the exercise could worsen their heart failure. This is true in the following instances:

  • If you are having significant heart failure symptoms. For example, if you are experiencing significant shortness of breath, leg swelling, or chest pain with any level of exertion, your heart failure is not well-managed and you likely wouldn’t benefit from cardiac rehab at this time.
  • If you have a history of irregular heart rhythms and your doctor has told you that you need a pacemaker or defibrillator. You should usually undergo these interventions before starting cardiac rehab.
  • If you have one or more medical conditions in addition to heart failure that may make exercise difficult. Examples include severe chronic obstructive pulmonary disease, poor muscle tone or function, or other heart conditions.

It’s important to carefully evaluate with a doctor if you are a good candidate for cardiac rehab. You should make an appointment to speak with one as soon as you can after a heart attack. If you are a good candidate, cardiac rehab can likely help you improve your quality of life.

When you have heart failure, your heart does not pump blood as effectively as it did before. If your heart rate gets too fast or your blood pressure gets too high, there is extra strain on your heart that keeps it from moving blood effectively.

As a result, a doctor may “prescribe” a certain heart rate range to ensure you can exercise safely. Since you will typically wear a heart rate monitor during cardiac rehabilitation, you and the cardiac rehabilitation staff can ensure your heart rate does not go too high.

The following chart illustrates how exercise intensity and maximum heart rate connect, according to the Centers for Disease Control and Prevention (CDC).

IntensityTarget heart rate ranges (%)
lowless than 55
moderate55 to 69
high70 to 90
maximal greater than 90

You may have noticed a term above called target heart rate. You can calculate your maximum heart rate using your age. You can estimate this by subtracting your age from 220.

Let’s consider an example. Your doctor has prescribed cardiac rehab to you at a moderate intensity (55 to 69 percent of the maximum value) and you are 65 years old. To calculate this:

  1. Subtract 65 from 220.
    • 220 – 65 = 155
    • 155 is your maximum heart rate.
  2. Next, calculate your safe heart rate range for exercising at moderate intensity.
    • 155 X 0.55 = 85.25
    • 155 x 0.69 = 106.95
  3. This means your desired heart rate for moderate exercise is between 85 and 107 beats per minute.

When you attend cardiac rehab, you can ask the personnel about your target heart rate and ways to ensure you stay within that number. Watching your heart rate monitor in rehab and slowing down if your heart starts beating too fast are good places to start.

What exercises can you do with heart failure?

When you think about exercise, it’s easy to think of running or kickboxing. But there are other exercise types beyond these high impact activities. Examples include:

  • Resistance exercises. This exercise type builds muscles by having you exercise against resistance. Lifting small weights and using resistance bands are examples of these exercise types.
  • Balance exercises. These exercises help you maintain your balance and typically have a mindfulness component. Examples include some yoga types and tai chi.
  • Aerobic exercises. These exercise types raise your heart rate to burn calories and increase your body’s oxygen demand. Examples of these exercises include walking, riding a bicycle, and swimming.

When you have heart failure, you may be able to complete most exercises. The key is to avoid placing too great of demands on your heart.

A cardiac rehab program will monitor your heart rate, blood pressure, and oxygenation to ensure you are safely exercising, warming up, and cooling down.

Sometimes, you may not be able to travel to a facility to regularly participate in cardiac rehab. When this is the case, home-based cardiac rehab can help. A 2019 review found that home-based cardiac rehab can improve heart function and quality of life.

However, the key is to make sure you’re exercising safely. One way you can do this is to monitor your heart rate to determine how much you’re challenging your heart when you exercise. There are many smartwatches and other at-home technologies that let you easily monitor your heart rate.

Make sure to always follow the guidelines and exercise plan given to you by your cardiac rehab team.

How do I know if my heart failure is getting worse?

When you have heart failure, it’s important to talk with your doctor about signs and symptoms that mean you need to seek medical attention. Be sure to listen to your body and consider the following.

According to the AHA, you should call your doctor if you have any of the following symptoms, which could indicate worsening heart failure:

  • abdominal swelling
  • dry, hacking cough
  • noticeable shortness of breath with any activity level
  • problems sleeping
  • swollen ankles, feet, or legs
  • weight gain of more than 2 to 3 pounds in a 24-hour time period

Call 911 or seek emergency medical treatment if you have the following symptoms:

  • appetite loss
  • frequent dry, hacking cough
  • inability to lie flat when sleeping
  • shortness of breath, even at rest
  • significant discomfort or swelling of the abdomen, ankles, feet, or legs
  • weight gain of more than 2 to 3 pounds in a 24-hour time period

If you have stable heart failure, your doctor may recommend cardiac rehab as a way to prolong and enhance your life. The educators at cardiac rehab programs can also help you identify healthy habits that may help you live better with heart failure.

If you’ve been diagnosed with heart failure, talk with a doctor to determine if you could be a candidate for cardiac rehab.