Introduction

Coronary heart disease (CHD), also known as ischaemic heart disease or coronary artery disease, is a common disease of narrowing or blockage of coronary arteries with fatty substances, causing reduced blow flow to the heart. Due to the nature of the disease, the patient’s quality of life can be impacted in various way, including issues with being active. However, physical activity is a key component in both managing and preventing further complications of the disease. By engaging in suitable exercises, the body is trained to be healthier, and the heart muscle strengthens, thus improving circulation, and enhancing overall well-being. 

Importance of physical activity with coronary heart disease

Regular aerobic activity is an effective way of strengthening the cardiac muscle. It is proven to develop chronic adaptation in the body, which can greatly improve the cardiovascular and musculoskeletal systems, including boosting oxygen delivery efficiency, and increasing endurance capacity and overall physical performance.¹ Doing aerobic exercise consistently may contribute to the body’s chronic adaptation,delivering favourable clinical outcomes. 

Not only does aerobic exercise help the heart to work better, it may also reduce the risk of having a second heart attack for people who have already had one. Since the heart is made of cardiac muscle, which is like any other muscle in the body, it can be trained to get stronger. A strong heart can pump more blood more effortlessly.

Benefits of physical activity with coronary heart disease

• Improved heart function: Having a stronger heart makes the heart work more efficiently
• Lower blood pressure: A strong heart can pump more blood with less effort, inducing less force to the arteries, known as the exercise training response,² therefore reducing blood pressure level
• Cholesterol management: Exercising can increase HDL (the good cholesterol that removes fatty deposits from the arteries), and decrease LDL (the bad cholesterol that promotes build-up of fat in the arteries)
• Improved mental health: Exercising releases happy chemicals from your brain, including endorphins, endocannabinoids, and dopamine. These overall reduce stress, anxiety, and depression, often linked with heart disease

Recommended physical activities for people with coronary heart disease

• Aerobic exercises

Aerobic exercises are the most effective way to improve your respiratory and cardiovascular functions. This enhances your heart's ability to pump blood more effectively to your lungs and throughout your body. As a result, more blood flows to your muscles, and oxygen content in the blood becomes more abundant.

Try to aim for 30–45 minutes of moderate-intensity aerobic exercise two to three times a week. According to the American College of Sports Medicine, aerobic exercise is a physical activity maintained continuously with large muscle groups.³

Exercises like walking, cycling, swimming, dancing, and jogging are recommended. With a consistent effort of doing aerobic exercise, arterial stiffness can be reduced, contributing to an overall healthier cardiovascular system.³

• Strength training

Other than aerobic exercises, consider incorporating some light resistance training. Typical cardiac rehabilitation programs suggest performing a combination of both resistance training and aerobic exercises.⁴ Resistance training involves exercises that cause muscles to contract against external resistance to increase strength, tone, muscle mass, or endurance. To put it simply, exercises that involve weights like dumbbells and machines to help you gain muscle. Evidence shows that with sustained strength training, patients who suffer myocardial ischaemia show ​​fewer signs and symptoms than the ones with solely aerobic training.⁴ 

For beginners, start resistance training with minimal weights such as resistance bands or light dumbbells, with a program consisting of 8 to 10 exercises, 2 to 3 days per week, with 1 set of 10 to 15 repetitions til you experience moderate fatigue.⁴ You might notice an incremental improvement every time you visit the gym, after 1 to 3 weeks. Try to experiment with slightly heavier weights depending on signs or symptoms and adaptation to training. To make it more effective, consider focusing on large muscle groups such as the chest, glutes and back.

• Flexibility and balance exercises

Cardiac rehabilitation also recommends exercise that boosts your joint flexibility and balance. It is crucial for overall mobility and reduces risks of injury. This kind of exercise can be simply done at home with minimal equipment and is more gentle and easy to follow.

Yoga is an excellent example to improve health. Yoga has been shown to improve quality of life in patients with coronary heart diseases and reduce cardiovascular risk factors for coronary heart diseases.⁵ Since yoga involves stretching poses, it is also beneficial for building up joint flexibility.

Guidelines for starting physical activity with CHD

• Consult a healthcare provider

Depending on your fitness level and disease severity, consult your physician before starting any exercise program. This is especially important if you take any medications or have medical devices implanted. A physician or exercise professional can assess your exercise responses to provide tailored recommendations based on your physical ability. Most people in cardiac rehabilitation can exercise with minimal problems. However, you should always discuss side effects or symptoms experienced during exercise with your cardiac rehabilitation team or GP.

• Start slow and gradual

Begin with light intensity to get your body prepared for the gradual increase in duration and intensity. At first, you might experience shortness of breathe or find it difficult to finish the exercise session. If you are consistent, you should notice an improvement in your physical ability over time.

• Monitor heart rate and symptoms

Be aware of your heart rate while exercising. If possible, monitor your heart rate with a smartwatch. It is also important to listen to your body and recognise warning signs during exercise. Know when to cool down and stop whenever you experience symptoms like chest pain, shortness of breath, nausea, or dizziness. Seek medical help if the symptoms prolong.

• Warm-up and cool-down

Always warm-up before exercising so your body is ready for the activities ahead. When the session is finished, don’t forget to do a cool-down to ease the heart out of the activity.

• Rest and recovery

Allowing time for the body to recover between sessions, it is completely fine to take rest days. 

Things to pay attention to while exercising with CHD

Even though exercises are considered to be universally beneficial, there are several considerations to exercise with coronary heart disease. For example, patient with an enlarged aorta is advised to avoid strenuous activities, such as those that involve straining or grunting, as these can promote extreme elevations in blood pressure. If you are on medication that impedes the blood's clotting ability, avoid activities that carry a high risk of bleeding like hockey, rock climbing and rugby. Besides, any contact sports that could cause direct trauma to the chest should be avoided, such as dodgeball or basketball.

Summary

Physical activity plays a vital role in managing and improving coronary heart disease (CHD). Regular and consistent exercises brings a multitude of healthcare benefits including strengthening the heart, lowering blood pressure, helping manage cholesterol, and enhancing mental well-being. For people with CHD, light exercises include aerobic activities like walking, strength training, and flexibility exercises, all tailored to individual capabilities. Starting slowly, consulting a physician, and monitoring symptoms are key to exercising safely and attaining the desired result. Cardiac rehabilitation programs also offer supervised, structured exercise to support recovery and long-term health benefits.