Should I Be Pushing Myself in Cardiac Rehab?

I was at cardiac rehab today and had an interesting conversation with the exercise physiologist. In fact, in case anyone is approved for cardiac rehab and is on the fence about going, I would say that the amount of knowledge in the professionals at cardiac rehab is incredible and one of the many reasons I would highly recommend that you participate in cardiac rehab if your doctor recommends it.

The exercise physiologist and I were talking about whether it is good to push yourself in cardiac rehab (versus remaining at your steady state) and how much pushing is good.

All situations are different

The exercise psychologist explained that first, each person's situation is unique; one blanket rule does not apply to all patients. Before engaging in an exercise program, patients should consult their care team to see what is safe and advised for them.

Please! Always consult your medical team first as each person's heart situation is unique and heart failure can be stable, unstable, etc.

Should I be pushing myself at cardiac rehabilitation?

If exercise is approved, why should we, as heart failure patients, think about pushing ourselves in cardiac rehab? Because pushing oneself is hard!!!

Per the American Heart Association, the goal of cardiac rehab is to "sustain aerobic activity." ¹ The exercise psychologist explained that the goal of cardiac rehab is incremental improvements over time. What felt physically hard for me this week ideally should feel less hard in the future.

This echoed what my heart failure team told me - exercise improves your overall functionality. As a caveat, I am not advocating exercise because it makes the burden of heart failure symptoms go away because for most people, the heart failure itself will not go away. I am one of those people who will never recover from my heart failure, and moreover despite all of my rehab (and there has been A LOT), I do not feel like my old self. However, I am proud that I am making the best of an unfortunate situation, and I am grateful for the little wins.

The exercise psychologist also said that exercise can, in some people, to some degree help strengthen the heart muscle. Again, if that is your main goal talk to your medical team.

Consulting the RPE scale

When I asked about how hard a heart failure patient should think about pushing oneself in cardiac rehab, I was reminded to consult the RPE scale or Ratings of Perceived Exertion.

The RPE Scale is common in cardiac rehab programs in the US, but heart failure patients in Canada and other locations please comment if you've seen this scale in your programs.

This RPE scale looks at how hard you perceive you are working. She advised me to stay within "Somewhat Hard" or "Hard." She said that 'Very Hard,' 'Very Very Hard' and 'Maximum Exertion' are too hard. The goal is incremental improvements. For example, she said that carrying on a conversation while working out should be challenging, but being completely out of breath or having chest pain meant that I should stop.

My message to other people with heart failure

Also, if someone is scared of starting cardiac rehab because they fear that the team will work them too hard, or not hard enough, I hope this helps allay your fears or confusion over the purpose of cardiac rehab!

This scale is based on the patient's perceived exertion, so cardiac rehab will ask you to push yourself, but the goal is incremental and steady improvement. I compare this to watching my fiancé workout with a personal trainer, who felt like if my fiancé's muscles weren't burning, then he wasn't working hard enough. I personally never felt like I was being pushed past my physical limit in cardiac rehab.

I hope this article helps those considering cardiac rehab, or folks like me who maybe have been at it for a while and need a gentle reminder to continue pushing yourself!  For people who are in Phase 3 Cardiac Rehab, or who workout on your own, how do you ensure that you are gently pushing yourself?