Introduction

Heart enlargement, or cardiomegaly, is a condition where the heart is abnormally enlarged. This can be assessed through imaging techniques, like a chest x-ray, which can visualize the heart and its chambers, such as the atria and ventricles.¹

Many heart diseases can result in cardiomegaly, and taking steps to manage risk factors can improve the quality of life for many individuals with cardiomegaly. 

Regular exercise, which increases the heart rate, can provide symptomatic benefits to those suffering from heart disease and can improve longevity compared to those who don’t exercise. Even small but consistent increases in physical activity can improve well-being and overall health.²

Understanding heart enlargement

Cardiomegaly results from the thickening or stretching of the heart chambers. It can be associated with multiple issues, such as: 

• Hypertrophic cardiomyopathy
• Health conditions like obesity and diabetes³
• Pulmonary hypertension⁴

An enlarged heart has more difficulty pumping blood around the body and uses up lots of energy, leading to symptoms such as breathlessness and fatigue. 

It is important to distinguish between cardiomegaly and athlete's heart, where prolonged exercise causes physical changes that can help athletes pump blood more efficiently during activity.⁵

Benefits of regular physical exercise

There are many studies that suggest that exercise can improve your mental and physical health. ⁶This section will focus specifically on how the heart changes in response to exercise and its effects on the rest of the body.

Strengthening the heart muscle

Repeated exercise can train the heart muscle to pump blood around the body more efficiently, as it causes changes in the heart muscle cells meaning that they can provide more energy.⁷

Reducing blood pressure

Blood pressure is also reduced by exercise as it causes the blood vessels to widen in a process called vasodilation, which allows more blood (carrying oxygen) to reach your tissues.⁷

Weight management

Exercise provides a way to increase the energy we use from stored fat, which is why it plays an important role in weight loss. Regular exercise over a prolonged period can contribute to weight loss and weight maintenance. Therefore, it can be implemented to reduce the risk of problems like heart attacks or cardiovascular disease, which often accompany obesity.⁸

Improving circulation

When we exercise, blood is pumped around the body faster to deliver oxygen to the muscles, which use it to produce the energy needed for movement.⁹ Faster circulation also means that waste products, like carbon dioxide, are removed from the tissues quickly.

Types of effective exercise

The NHS recommends that adults aged 19 to 65 do at least 150 minutes of moderate physical activity per week. Moderate physical activity is the level of activity that makes you feel warmer and raises your heart rate, but at which you are still able to hold a conversation. Children can do aerobic exercise, and the elderly should focus on light activity which focuses on movement, such as strength training. 

You should consult a healthcare provider if you have not exercised for a long time, and they can guide you on increasing your physical activity.

Aerobic exercises

Cardio, also known as aerobic exercise, increases your heart rate. It usually consists of repetitive and structured movement.¹⁰ Forms of cardio include:

• Walking
• Jogging
• Cycling
• Swimming 

150 minutes per week of moderate activity, such as walking, is recommended for all adults to improve general health.

Strength training

Strength or resistance training can increase lean muscle mass, which uses up more energy even when not being used, and so can aid weight loss. It also provides more general benefits, such as better physical and mental performance.¹¹

To maximise benefits from resistance training, you should aim to incorporate progressive overload in your routine. This involves a gradual increase in the weights used or the number of repetitions or sets that you perform. 

Increasing muscle strength is achieved by at least three sets of five to eight repetitions, with a high load. Training muscle endurance, on the other hand, can be done by using lower loads with higher repetitions. 

Strength training can reduce the amount of low-density lipoprotein cholesterol (LDL) in the blood, which is the bad type of cholesterol. A high level of LDL cholesterol can lead to the buildup of fat in the blood vessels, which raises the risk of heart disease.¹²

Flexibility and balance exercises

Participating in flexibility exercises can reduce aches and pains and prevent injuries (especially in older people).¹³

Sessions can be up to 20 minutes, and activities can include things like:

• Tai chi
• Yoga
• Pilates
• Stretching

These can reduce the risk of falls and make daily tasks easier.

Recommended exercise guidelines for managing heart enlargement

Before starting exercise, it is important to consult a healthcare provider who can provide personalised guidance. This is because exercise can cause you to breathe slightly faster if you have an enlarged heart due to additional constraints on the lungs, and it is important to make sure that exercise is being started safely.¹⁴

Also, tailored exercise plans can be more effective as they take into account your personal needs and goals. Someone who is older and has heart disease will require a different exercise routine than a younger, healthier person. 

Safety considerations must also be made for the different types of cardiovascular conditions that you may have to make sure that you carry out the routine without hurting yourself or negatively impacting your condition.¹⁵

Setting realistic goals 

For most people, it is important to gradually increase the intensity and duration of exercise. The starting point may vary for each individual, depending on their lifestyle and other health conditions. 

Monitoring progress can be achieved through tracking weights and reps on a notes app or through measuring muscle mass and weight. BMI can usually be a good indicator of health (unless you are a bodybuilder), but it does not take into account your muscle mass. 

Additional lifestyle factors

Exercise should be combined with a diet that promotes good cardiovascular health. Avoiding food that is high in LDL cholesterol can help to reduce blood pressure. Most ultra-processed foods will have these, so avoiding these is important, and having a balanced diet with enough carbohydrates, protein, fat and fibre promotes heart health.¹⁶

Furthermore, regular check-ups can give you a better picture of your health. A healthcare consultant can give you personalised recommendations to implement into your lifestyle.

Managing stress and mental health can also help you feel your best. Yoga usually has a strong emphasis on meditation, which is helpful for relaxation.

Summary

Regular physical exercise can help individuals with cardiovascular diseases that lead to heart enlargement (cardiomegaly).

Adopting an active lifestyle can be beneficial for people who want to reduce their risk of heart disease, diabetes and obesity. This can be taken further by eating well and having good mental health resources. 

Making these changes can have a positive impact on your overall well-being and help you live a longer life.