EXERCISE

DURING
Is it safer for you to If you have a heart condition, it is still very important to keep physically active. It will
become more active? help to maintain your heart health and may prevent your heart disease from getting
worse. There are many different ways to keep active and it is important to find
activities which are safe and right for you. It is also important that you build your
activity levels up gradually.

Your cardiac rehabilitation team have given you this exercise DVD after a thorough
assessment of your fitness and recovery so far; they have explained which level of
exercise to follow and how to record your progress and your RPE. These exercises
are a safe and effective way of becoming more active following a heart condition.

Are there any activities If you have a heart condition, you may be advised to avoid some everyday activities.
you should avoid? It’s worth talking this with us. You should also avoid competitive sports that require
sudden bursts of energy.

What if your family This is very common. Those close to you may be scared that you will overdo it. Show
don’t want you to do them your exercise DVD and these booklets. It should help set their minds at rest
anything active? knowing that it has been given to you by your physician’s recommendation.

Your family will be more likely to encourage you to keep up the exercise. It may also
help them and make it more enjoyable if they do exercise with you.

The stages Warm up (15 minutes)

This prepares your body for exercise. The gradual buildup of activity improves the
blood flow to the heart and working muscles. This helps the oxygen get to where it is
needed. The stretches at the end of the warm up improve your range of movement.

Conditioning phase (20 minute)

This is the main part of the exercise session and will help tone and strengthen your
muscles and improve your heart’s efficiency. You will be able to progress through
the different levels of exercise with the advice of us.

Cool down (10 minutes)

This part of the exercise is about gradually slowing down your exercise so that your
heart rate and blood pressure return to normal. They will both have risen during
exercise. You repeat the stretches to try and help prevent any stiffness which you
might feel later and to improve your flexibility.

Monitoring exertion on During the work we want you to use this scale to rate your perception of exertion, ie,
Borg RPE scale how you heavy and strenuous the exercise feels to you and how tired you are. The
perception of exertion is mainly felt as strain and fatigue in your muscles, as
6 No exertion at all breathlessness or some aches.
7 Extremely light
8 6 “No exertion at all”, means that you don’t feel aches, muscle fatigue,
9 Very light
10
breathlessness etc.
11 Light 9 “Very light” exertion, as taking a shorter walk at your own pace.
12 13 A “somewhat hard” work, but it still feels OK to continue.
13 Somewhat hard 15 It is “hard” and tiring, but continuing isn’t terribly difficult. This is often hard
14 enough.
15 Hard (heavy) 17 “Very hard”. This is very strenuous work. You can still go on, but you really
16
have to push yourself and you are very tired.
17 Very hard
18 19 An “extremely” strenuous level. For most people this is the most strenuous
19 Extremely hard work they have ever experienced.
20 Maximal exertion
(Try to appraise your feeling of exertion and fatigue as spontaneously and as honestly
as possible, without thinking about what the actual physical load is. Try not to
overestimate your exertion. It’s your own feeling of effort and exertion, not how this
compares with other people.
 Look at the scale and expressions and then give any number on scale (not just the one
with an explanation behind it).

INSTRUCTIONS /GUIDELINES

Monitor yourself Someone from your cardiac rehabilitation team should have explained how to monitor
and pace yourself while you are exercising. They will also have spoken about the
importance of the warm up and cool down.

It is really important that you have read and understand the information in this
booklet, and that you know on which level of exercise you should start, if you are
unsure about anything, please contact your physician and me to help you.

Getting ready  Wear loose, comfortable clothing that helps you to move freely.
 Clear enough space in the room so you can take three steps in any direction
 Keep the temperature comfortable (open a window so you don’t get too hot)
 Don’t exercise for at least two hours after eating food, or drinking alcohol.
 Have a glass of water to hand during the exercise and at the end to replace fluid you
lose during the session.

How should you feel  Before you start any exercise, make sure you are rested and feel well.
before exercise?  You should not start the exercise and should contact us if-
your heart beat feels irregular and this is not normal for you
you have a temperature or feel generally unwell
you have chest pain when resting

How you might be When you are exercising it is normal to feel-

feeling when you slightly sweating
exercise warm or slightly flushes
you are breathing deeper and faster, but can still talk
your heart beating faster

However, you should slow down and make the movements smaller if-
your breathing is uncomfortable
you feel excessively tired or are sweating a lot
your perceived exertion score is higher than recommended by your cardiac
rehabilitation team/ physician.

If your RPE doesn’t go down when you have tried to slow down and reduced the
movements for a few minutes, walk on the spot slowly

If you are still having problems after a couple of minutes, stop and sit down in a
supportive chair.

You should also stop, sit down and not resume the exercise program that day if-
you feel dizzy
you feel chest pain
your heart beat becomes very irregular

These are abnormal responses to exercise and may be a result of overdoing it. You
should discuss any of these responses with us before your next exercise session.

What to do if you have  Stop what you are doing

chest pain, discomfort  Sit down and rest.
or tightness If you do not have nitroglycerine spray, tablet etc., you should rest, stay calm and call
your physician, me or 108.

If you have a Nitroglycerine spray or tablet, use it as you have told to do.
 If pain, discomfort or tightness doesn’t ease after five minutes, take another dose.

If the pain doesn’t ease within 5 minutes of your second dose, call your physician, me
or 108 straight away.

If you are not allergic to aspirin, chew one adult tablet (300mg). If you don’t have
any aspirin to hand or nearby or you are not sure if you are allergic or not, you should
rest until the ambulance arrives.

Warm ups
I) PULSE RAISING EXERCISES FOR LEVEL-1/ K-1
Correct posture:-
1. Feet apart, gentle bend of knees, straight spine, head up (as some string is pulling you towards ceiling)
2. Take shoulders forward, up, back and gently down
3. Breath in and while breathing out pull your tummy tightly towards spine and release 50% and now keep
this good posture throughout the exercise program

Feet apart Shoulders forward Shoulders up Shoulders back Shoulders gently down

Stepping/ March on a spot

1. Relax shoulders and start marching on a spot as it
will help in raising pulse.
2. Begin it very slowly and gradually raise its intensity.
3. Do it throughout the exercise program.

Toe tapping
1. Gently bend supporting leg, tapping the toe onto the
floor in front of you.
2. Do it 6 times on each leg
3. Then again continue marching at the spot

Heel dig
1. Gently touching the floor in front of you with the
heel of your foot.
2. Do it 6 times on each leg
3. Then again continue marching at the spot
Knee raise/lift
1. Raise the knee slightly.
2. Tap knee with alternative hand while raised.
3. Do it 4 times on each leg
4. Then again continue marching at the spot
 (If you feel some discomfort then stop raising knee
and just touch the floor in front of you)
Legs going sidewise
1. Gently tap the foot sidewise, try not to take the leg
too far
2. Keep your body-weight firmly onto the supporting
leg.
3. Do it 4 times on each leg
4. Then again continue marching at the spot
Legs going back
1. Move the leg backward (try not to take the leg too
far), gently tap the floor with the toe by keeping the
heel off the floor
2. Keep your body-weight firmly onto the supporting
leg.
3. Do it 4 times on each leg
4. Then again continue marching at the spot
Spine twist/ side bends
1. Move feet apart at hip distance
2. Keep your toes moving
3. Bend to sidewise as per your comfort.
4. Come back to middle of the body
5. Do it 4 times on each side
6. Then again continue marching at the spot
Spine rotation
1. Move feet apart at hip distance
2. Keep your toes moving
3. Keep hands across the chest.
4. Move to the right
5. Come back to middle of the body
6. Do it 4 times on each side
7. Then again continue marching at the spot

PULSE RAISING EXERCISE FOR K-2, K-3 AND K-4, K-5

Exercises are same as that of in K-1 but the intensity is little high as compared to K-1 exercises. Following
are the differences/ changes in these exercises in Low intensity levels (K-2 and K-3) and in High intensity
levels (K-4 and K-5) as compared to K-1.
Exercises Low intensity level (K-2 and K-3) High intensity levels (K-4 and K-5)
March on March on the spot with good arm swing March on the spot energetically like a soldier
spot
Shoulder Slightly bend elbows and start exercise as
rotation you are trying to comb your hairs (do not
move your hand over the head). Do it 4 times
and then move hand from back to front in
order to cause full shoulder rotation.
Bend elbows and start exercise as you are
trying to comb your hairs. So, move your
hand over the head towards back more
energetically. Do it 4 times and then move
hand over the head from back to front in
order to cause full shoulder rotation.

Toe Low bend of leg and do toe tapping as Bend supporting leg and do toe tapping as
tapping mentioned in K-1. When you get good mentioned in K-1. When you get good
rhythm then add bicep curls along with toe rhythm then add bicep curls with big arm
tapping. movements.

Heel dig Do it as mentioned in K-1 and also add arm Bend supporting leg quiet low and carry out
swing or bicep curls. all the steps as mentioned in K-1 and add big
arm movement in it.

Knee raise Knees should be raised at 45ᵒ (less than hip Knees should be raised at 90ᵒ (go up to hip
level) and arms should move more level) and arms should move more
energetically energetically

Legs going Try to move leg a little far and add a gentle Bend the supporting leg. Move the working
sidewise arm swing leg a little farther and add big arm
movements.
 Legs going Slightly bend the supporting leg. Try to move Bend the supporting leg. Move the working
back the working leg a little far and add a gentle leg a little farther and add big arm
arm swing movements. When you get good rhythm, you
can add bicep curls in it

Side bends Do exercise as mentioned in K-1 but keeping Do exercise as mentioned in K-1 but keeping
in mind as to bend sidewise so far as your in mind as to bend sidewise so far as your
arms should go down up to knees. arms should go down the knees.

II) STRETCHING EXERCISES (These are same for all levels)

The next 5 minutes of warm-up needs to be given to stretch those muscles that you are going to use. Do
not stretch beyond the capacity of muscles. Should always keep feet moving to maintain heart rate and
body temperature still slightly raised.
a) Upper back stretch
Stand straight, lock fingers together with arms stretched-out
in front as you are hugging a fat person. Drop your head
towards the floor. You will feel a gentle stretch at the top of
your back. Keep moving your feet. Hold this position for
10-15 secs. Then gently release the tension.

b) Arm stretches
Put your one hand on your shoulder and bring hand upon
your shoulder blade. With the other hand slowly impel the
flexed arm back till you feel a tension underneath that arm.
Repeat this with other arm. Another way can be by keeping
an arm straight across the body at a shoulder height. Gently
press straight arm into your body with other hand to bring a
tension in the back of straight arm.
c) Chest stretch
Put hands on the lower back and push forward your chest
until a tender stretch is felt in front of chest or if you are
 comfortable, place the hands on the temples and draw the
elbows back. You will feel a stretch across the chest. Then
gently release the stretch. Keep marching.
d) Calf stretch
Stand as shown in figure with the front leg flexed at knee
whereas back leg straight keeping heel high, not taking too
bigger step backward. Now gently ease the heel into the
floor. Remember both toes should be pinpointing forward.
Feel a gentle stretch in calf muscles. Do this whole process
on other leg. Don’t forget marching on the spot.
e) Hamstring stretch
Take feet gently apart at hip distance. Try to lean forward
as you are going to sit on table. Gently bring right leg
forward as shown in figure. With the hands on the top of the
thighs gently bend forward as you are looking at the floor
in front of you. This will bring a tension in the back of thigh
(between knee and hip), otherwise to create tension raise off
the toes of front foot from floor so that weight should be on
heel. Bring body to normal position and perform on the
other leg.
If you are unable to perform this in standing position try
to sit on the margin of chair and other all steps are same as
in standing position like placing hands on thigh and leaning
forward.
f) Thigh stretch
Keeping your body straight, feet a hip distance apart thus
holding onto a wall or sturdy chair/table with one hand and
with another hand grasp your ankle, slowly pull your leg
towards hips (if you are not able to grasp ankle then you
can grasp shoe laces or tracksuit bottom). Keep both knees
in straight line. This will create a tension in the thigh of
flexed leg. Release leg slowly and repeat on other leg.

MAIN EXERCISES/ CONDITIONING EXERCISES (LEVEL-1)

To move from warm-up exercises to main exercise, you should keep on moving your feet, swinging the
arms, posture nice and straight, tummy pulled in and the knees are coming quiet high in knee raise
exercise. If you need support, you can hold onto a chair etc. Repeat every exercise 12-15 times/minute.
If it counts more that means you are working fast and vice-versa.

Legs going sidewise

Bend the supporting leg gently. Once you feel that is
comfortable, you can start doing arm-swing along with
movement of legs. (Note: If you feel that you are getting
puffy, tired or uncomfortable then don’t use arms at all)

Bicep curls
If you feel comfortable, you can perform this exercise by
using weight. Stand straight with nice posture, palms facing
up, elbow into the body, shoulders down and relax and thus
slowly raise hands towards the shoulders and then gently
back down to normal position. (Note: If you are using weight
then take care of not to grasp the weights too tightly as to use
only forearms muscles and thus the hands must be relaxed)

Hamstring curls
Taking feet at hip distance apart, lift heel to the hip and
gently swipe. Gently put full body weight on the supporting
leg and a nice comfortable flip behind. When you are ready,
you can add a small arm-swing in it towards front of you.
Now back to the march.

Wall press-up
First of all find a nice steady wall. Place your hands against
the wall about shoulder distance apart and fingers facing
towards ceiling. Take one small step away from the wall.
Keep feet in motion. Gradually lower your nose towards wall
and slowly move away by putting weight on the arms and
the shoulders. Remember while bringing nose towards wall
only your toes should touch the floor.
If you are finding exercise to easy then take a bigger step
away from the wall and then repeat all steps again. However,
if find exercise hard then take a smaller step instead.
Knee raise
Raise the knee slightly not higher than hip height. If you are
comfortable you can slightly bend supporting leg. Tap knees
with alternative hands while raised. Add nice and rhythmic
arm swing in exercise while raising knees. If you find it
harder then stop raising knee and just touch the floor in front
of you while keep on continuing your arm swing. Then again
continue marching at the spot.

Lateral arm raise

If you want to use weight then pick-up weights now. Keep
nice posture with hands in front of your body and slightly
bend elbows. Slowly taking arms to the side upto the
shoulder level and back to the initial position. Take care not
to go above the shoulders. Take care not to hold your
breathe. If you feel this is quite challenging you can bend
your elbows, it will make the exercise slight easier and then
perform same steps.

Back lunges
Keep feet hip distance apart and tap behind with the ball of
foot or toes. Keep heels well away from floor. When you get
a good rhythm, add arm swing. If you are asked to record
your RPE and heart rate, you will be asked to do so while
your feet are moving.

Upright row
Keep good posture, hands in front of body. Raise the hands
between chin and chest. You can do it with or without
weights. Keep shoulders relax and at normal position. Do
march with big arm swing if you are comfortable with that.

Chest exercise
Brings arm upto the shoulder height, bend the elbows, relax
the hands and squeeze the elbows and release as you are
going to pop a balloon between your elbows. March at the
spot with a good arm swing.
 Tap to the side
Gently tap the foot sidewise. Keep your body-weight firmly
onto the supporting leg. Tapping out and in adding up arm
movements as well. Move as much as you feel comfortable
without being puffy.

Biceps curl
Take some weights (small bottles filled with rice) in hands.
Slowly lift weights upto shoulder height and then bring them
to the initial position. Try not to grasp bottles too tightly. If
you feel shoulders are tired then you drop down weights and
continue your exercise again.

Hamstring curls
Keep feet at hip distance apart, roll heels back towards
bottom. As you swing, keep your back central and tummy
pulled in. When you are happy with that movement than start
arm swing along with leg movements. If you feel puffy then
bring arms down and continue the exercise without arm
swing.

MAIN EXERCISES/ CONDITIONING EXERCISES

Exercises are same as that of in level-1 but the intensity is high as compared to level-1 conditioning
exercises. Following are the differences/ changes in these exercises in other levels.
Exercises Level-2 Level-3 Level-4 Level-5
Legs going Gently bend Instructions are same Bend supporting leg Instructions are same
sidewise supporting leg. Do as for level-2 but in more at the knee. as for level-4 except
not move leg too far. this level the arms Move the other leg that the arms should
During arm swing the should move up to as far as it is possible move above the
arms should be kept shoulder level during under your comfort shoulder level (If
below the shoulder arm swing and the arm should you start feeling
level move up to the puffy, then keep the
shoulder level more pace down and move
energetically during arms up to shoulder
arm swing level.

Bicep Pick weight and roll Pick weight and roll Pick weight and roll Pick weight and roll
curls up your arms up to up your arms up to up your arms up to up your arms up to
 shoulder height. Do shoulder height. Do shoulder height. Do shoulder height. Do
not grasp bottles too not grasp bottles too not grasp bottles too not grasp bottles too
tightly. tightly. tightly. tightly.

Hamstring Instructions are same Same as in level-2 Same as mentioned Same as mentioned
curls as in level-1 except except that the arms in level-3 in level-3 except that
with a good arm should move up to the arms should
swing throughout the the shoulder level move above the
(If you are exercise. during arm swing shoulder level
asked to
record your
RPE and
Heart rate
then record
and write it
on log book
immediatel
y after this
exercise)

Wall Same steps as Same steps as Legs should be kept Same as mentioned
press-up mentioned in level-1 mentioned in level-1 more than one feet in level-4
but should repeat it far from the wall to
12-15 times per make the exercise a
minute. More or less bit harder.
than these indicates
that you are working
too fast and vice-
versa.

Knee raise Same as mentioned in Raise the knees at 45 Raise the knees at 90 Raise the knees at 90
level-1 but add good degree to hip level degree to hip level degree to hip level
arm swing while and add big arm and add strong, with arms moving
raising knees swing. energetic and big above shoulder level
arm swing up to during arm swing.
shoulder level
Lateral Same as mentioned in Same as mentioned Same as mentioned Same as mentioned
arm raise level-1 in level-2 in level-2 but arms in level-4
should go above
shoulders.

Back Bend the supporting Bend the supporting Bend the supporting Bend the supporting
lunges leg gently while arms leg nice and deep. leg deeper. Move the leg deeper. Move the
should move up to Move the other leg arms above shoulder other leg as far from
shoulder level during as far as it is possible level. you. Move the arms
arms swing and comfortable for above shoulder level.
you. Add more
energy in arm swing
while moving them
at shoulder height.

Upright Same as mentioned in Same as mentioned Same as mentioned Same as mentioned

row level-1. Repeat it 12- in level-2 in level-2 in level-2
15 times per minute.
More or less than
these indicates that
you are working too
fast and vice-versa.

Chest Same as mentioned in Same as mentioned Same as mentioned Same as mentioned

exercise level-1 in level-2 in level-2 in level-2

Dynamic The knees should go The knees should go The knees should go The knees should go
march higher than at 45 degree angle to at 45 degree angle to at 90 degree angle to
mentioned in level-1 hips with big arm hips with more hips with more
(If you are with good arm movements. energetic arm energetic arm
asked to movement. movement. movement.
record your
RPE and
Heart rate
then record
and write it
on log book
immediatel
y after this
exercise)

COOL-DOWN EXERCISES
We have to perform such exercises as we did to raise pulse/ heart rate and to improve stretches in reverse
manner so as to gradually bring the heart rate to its pre-exercise state. Thus, we have to move from bigger
movements to slow movements.
K-3 level

Toe tapping
Gently bend supporting leg, tapping the toe onto the floor
in front of you along with arm swing which should move
up to the shoulder level in K-3 level. Do it 4 times on each
leg. Then again continue marching at the spot.
Heel dig
Gently touching the floor in front of you with the heel of
your foot as you did during warm-up session while add up
the arm swing in it (if you feel comfortable or untired). It
will be perfectly ok to slightly bring down the arms at
lower level in case you feel tired or uncomfortable. Do it 4
times on each leg. Then again continue to march at the
spot.
Knee raise/lift
Raise the knee slightly. Tap knee with alternative hand
while raised using a good arm swing. Repeat it on other
leg. Do it 4 times on each leg. Then again continue
marching at the spot. (If you feel some discomfort then
stop raising knee and just touch the floor in front of you
while keeping the arms swinging)
Legs going sidewise
Gently tap the foot sidewise, try not to take the leg too far.
Keep your body-weight firmly onto the supporting leg. Add
good arm swing. Remember to bring arms to shoulder level
until you feel uncomfortable. Do it 4 times on each leg. Then
again continue marching at the spot.
Legs going back
Move the leg backward (try not to take the leg too far), gently
tap the floor with the toe by keeping the heel off the floor.
Keep your body-weight firmly onto the supporting leg. Add
good arm swing. Remember to bring arms to shoulder level
 until you feel uncomfortable. Do it 4 times on each leg. Then
again continue marching at the spot.
Cool down exercises in K-2 and K-1 levels
Exercises are same as that of in K-3 level but the intensity is low as compared to K-3 level cool down
exercises. Following are the differences/ changes in these exercises in K-2 and K-1 as compared to K-3 level.
Exercises K-2 K-1
Toe tapping Low bend of leg and slow arm movement Gentle tap without any arm movement
(that should be below shoulder level)
Heel dig Slow arm movement (that should be Gentle tap without any arm movement
below shoulder level)
Knee raise Knees should not go higher than hip level Slightly raise knee or preferably tap toe
and arms movement should not be to in front of you without any arm
vigorous movement
Legs going Legs should not go too far Legs should not go too far and there
sidewise should not be any arm movement
Legs going Take small step and arms should swing Legs should not go too far and there
back lower than shoulder level should not be any arm movement

STRETCHING EXERCISES
Upper back stretch Arm stretches Chest stretch

Calf stretch Hamstring stretch Thigh stretch

 PHYSICAL ACTIVITY DIARY

HEART RATE MINUTES OF HEART RATE

MINUTES OF MINUTES OF COOL BORG EFFORT
DAY OF WEEK DATE BEFORE MAIN AFTER COMMENTS/ COMPLAINTS
WARM UP DOWN SCORE
EXERCISE EXERCISE EXERCISE