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the Active Heart Table of Contents About this book............................1 About cardiac rehab....................2 What is cardiac rehab?................3 Your exercise plan................... 4–5 The test.....................................5 Before you exercise.....................6 Warm up and cool down.........6 After you exercise........................7 Stretching.................................7 Taking your pulse........................8 About exercise........................ 9–12 Aerobic exercise.......................9 How hard to exercise.............10 Weight training......................10 Exercise record.......................11 At home..................................12 Setting goals...........................12 Cardiac rehab goal....................13 Not too easy................................14 Not too hard...............................15 When to stop..........................15 The right diet..............................16 Read all food labels....................17

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2017 Edition Copyright © 1997, 1998, 2006 by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.

This book is only to help you learn. It should not be used to replace any of your health care team’s advice or treatment.

Published and distributed by: Pritchett & Hull Associates, Inc. Printed in the U.S.A.


bout this book

If you’ve had a heart attack or other heart problem, it doesn’t mean you must feel like a “sick person” for the rest of your life. Cardiac rehab helps many people become more active and feel better than they have in years. So don’t settle for “being alive.” Let cardiac rehab help you “feel alive” and “act alive.” This book will help you with the exercise part of your rehab program. It has spaces for you and your rehab team to write in things you need to know. Take this book with you to your cardiac rehab classes.

Name:_______________________________________________ Address:______________________________________________ Phone:_______________________________________________ Cardiac Rehab Program:_______________________________ Program Director:_____________________________________ Phone:_______________________________________________ Class Days:___________________________________________ Class Times:__________________________________________



bout cardiac rehab

Cardiac rehab helps heart patients get well sooner and return to a full, active life. It has 2 parts:

Exercise training to help you:

• exercise safely

• strengthen your muscles

• get your energy back


Education and counseling to help you:

• understand your heart condition

• find ways to change bad health habits to new, healthy ones


hat is cardiac rehab?

This is a planned program to improve your health so your heart doesn’t have to work too hard. Most people in rehab programs have had some type of heart problem. Cardiac rehab begins in the hospital and continues after you go home. In the hospital, you may exercise very lightly and learn about risk factors for heart problems. After you leave the hospital, you begin rehab classes. You will likely go to class about three times per week. In class, you learn to check your heart rate and know how hard you are working. You may be hooked up to telemetry (EKG machine) for a short period of time. This is so your rehab team can check your heart’s rhythm while you exercise. You will also learn more about risk factors and smart food choices. As you improve, you can begin to do some of your exercises away from the program. When you are stable, you may decide to do all your prescribed exercise program at home or a place other than the cardiac rehab program. Remember, the cardiac rehab team is always there for you.



our exercise plan

Your plan is your road map for cardiac rehab. You may do the same exercises each day or do different routines. As you improve, your rehab team may change your plan to match your fitness level. Your plan will be based on your strengths and needs. First, you will likely have a “graded� exercise test. This means you exercise while someone records how your heart responds. The exercise slowly gets harder to gently test your heart. Your rehab team will choose the right exercise for your test. You may walk on a treadmill, ride an exercise bike or use some other machine. No matter what machine you use, a graded exercise test is safe. Your rehab team will not make your heart work too hard. They will use your test results to plan a safe exercise plan for you.


The test During the test, you exercise while attached to an EKG machine. Wires run from small pads (electrodes) on your chest to the machine. Your heart rhythm and rate are shown on a screen. Your rehab team records your blood pressure and how hard you’re working. The amount of oxygen you use when exercising as hard as you can is measured. That amount is figured in metabolic units (METs). (One MET is how much oxygen the body needs when you are at rest.) The rehab team uses your MET level, along with your heart rate and how hard you feel you are working (“Rate of Perceived Exertion” or RPE—see p. 10), to prescribe your program. Your resting and peak heart rates help your rehab team figure your target heart rate range. This is where you want your heart rate to be during exercise. They will tell you what your range is and how it was figured. Ask them to record your test results and exercise ranges here.

Graded exercise test results Date:__________________________ Protocol:_______________________ _______________________________ _______________________________ How long:______________________ _______________________________ Resting heart rate:_______________ Peak heart rate:_________________ Target heart rate range: _______________________________ Peak MET level:_________________ Target MET range:______________ Peak RPE:______________________ Target RPE:_____________________ Notes:_________________________ _______________________________



efore you exercise

If you start working out before your body is ready, you may hurt yourself. Your body needs time to move blood to the places that need it during exercise. There are a few things you need to do before you start sweating.

Warm up and cool down The best warm-up is one that uses the same muscles you use during your exercise. If you plan to ride a bike or walk, go very slowly for 5 to 10 minutes before you go faster. Before you stop exercising, slow your pace and cool down slowly. This lets your body gently return blood from your muscles to other places. Wait until your pulse has slowed before you shower. Don’t shower in very cold or very hot water—this can be a shock for your heart.



fter you exercise

Stretching Stretching may prevent painful muscle pulls, cramps and soreness. But never stretch cold muscles and no bouncing during stretching. When you are through working and cooling down, stretch your muscles. This may help you avoid feeling stiff and sore later. Your rehab team will show you how to stretch.

NOTE: A good stretching routine after exercising should last about 10 minutes.

What you do before exercise affects how hard your heart works during exercise. In the two hours just before exercise, do not: smoke

eat a heavy meal

drink caffeine

drink alcohol



aking your pulse

When you exercise, check your pulse to see if you’re within your target heart rate range. Check your pulse on the inside of your wrist below your thumb. To take your pulse: 1. Put your first two fingers where you feel your pulse. 2. Count how many beats you feel in 15 seconds. 3. Multiply this number by 4. This is your 1-minute heart rate. Sample pulse rate: 36 (# beats in 15 seconds) x4 = 144 (your 1-minute heart rate)

NOTE: If you can’t feel your pulse in your wrist, you may be able to take it from your neck. This makes some people feel dizzy or faint. Ask your rehab team before you try it.



bout exercise

In cardiac rehab you will do mostly aerobic exercise with some weight training.

Aerobic exercise This trains your body to use more oxygen. It:

has rhythmic movement

lets you stay in your target heart rate range

uses large muscle groups such as your legs

There are lots of aerobic exercises you can do in one place—like riding an exercise bike or walking on a treadmill. Other exercises you can do at home include: dancing

stair climbing

rowing swimming Your rehab team can tell you how much exercise you need. It depends on your health and how hard you can exercise. Your goal is to work up to exercising at least 30 minutes, 5 or more days each week.


How hard to exercise

Rate of Perceived Exertion

You need a way to tell your rehab team how hard you exercise. Many people do this by using a scale of exertion.* If you are working as hard as you can, your level is 10. If you are barely trying, your level is 1. For most people, from 3 to 4 are good levels. Check your heart rate so you can tell your rehab team how hard you are working. If you have a smart phone, there are many apps that will monitor your heart rate for you. Check the App Store or Google Play.

0.0....... nothing 0.5......... very, very light 1.0......... very light 2.0......... light 3.0......... moderate 4.0......... somewhat hard 5.0......... heavy 6.0 7.0......... very heavy 8.0


10.0......... very, very heavy

Weight training You may also do some weight training in cardiac rehab. You lift weights to make your muscles become stronger. But lifting heavy weights can be hard on your body. It is better to lift lighter weights over and over. Do not lift weights on your own. Start with light weights in your rehab program. Ask your doctor or rehab team before you lift weights outside of class. * often called Rate of Perceived Exertion (RPE)



Blood pressure Heart rate

RPE score

Blood pressure

Heart rate

RPE score

Blood pressure

RPE score

Blood pressure

Heart rate

Blood pressure Heart rate

ŠPritchett & Hull Associates, Inc. Patients may copy this page.


Stretches:_______________________ Time:

Cool-down:_____________________ Time:

RPE score

Ex. 5:_______________________ How long:

Ask your rehab team to show you how to record the exercises you do in class. You may make copies of this page to use in your program.



Heart rate Â

Ex. 4:_______________________ How long:

Ex. 3:_______________________ How long:

Ex. 2:_______________________ How long:

RPE score

Ex. 1:_______________________ How long:

Fill in Exercise



Exercise record

At home Do not exercise at home until your rehab team says it’s OK. When you are ready, they will help you set up a home exercise plan. This will help you exercise on days you are not in rehab class. You must keep exercising to help your heart get stronger. Once again, your goal is to work up to exercising for at least 30 minutes, 5 or more days each week.

Setting goals For a healthy, active life, you must commit to a healthy lifestyle. Setting goals can help you do this. When you set a goal, make sure it is a challenge—but also within your reach. Your rehab team can help you set goals that are right for you and your heart. Some common goals involve:

regular exercise

not smoking

weight control

cholesterol control

diabetes control

medicines diet blood pressure control


stress management


ardiac rehab goal

Make copies of this page. With the help of your rehab team, use the copies to record each of your goals. Check your progress every few weeks, and talk with your rehab team about how you are doing.

Name: Goal:

4-week check-up date:

10-week check-up date:



6-week check-up date:

12-week check-up date:



8-week check-up date:

Questions for your rehab team:


Š Pritchett & Hull Associates, Inc.

Patients may copy this page.



ot too easy . . .

At first, you may be afraid to exercise. But you must exercise to help your heart get stronger. Listen to your cardiac rehab team. Follow your plan, and tell them how you feel. Soon you will feel safer about exercising. Your loved ones may be afraid, too. If they are, ask them to visit your rehab class. They may be surprised to see how well you can exercise. Seeing you in class may help them relax.



CAUTION: When you exercise at home, stay within your target heart range.


ot too hard

You may think your heart will heal faster if you exercise as hard as you can. But your heart needs time to heal slowly and safely.


CAUTION: When you exercise at home, stay within your target heart range.

Never increase how hard you exercise without asking your doctor or rehab team first.

When to stop There will be times when you should stop exercising. These are called end points. An end point may be:

increased or unusual shortness of breath

chest pain

feeling very tired or dizzy


a pulled muscle

an irregular heartbeat

You may have your own end points, too. Listen to your body, and know when it’s saying “STOP!” If you ignore an end point, you could be in danger.

NOTE: If your doctor has prescribed nitroglycerin pills for your chest pain, keep them with you at all times.



he right diet

Cardiac rehab is more than just exercise. It’s also about making changes in your life. One of the best things you can do for your heart is commit to a diet for your heart. The “love your heart” diet has: less fat and cholesterol— These clog your arteries so less blood can reach your heart. less salt (sodium)— This may raise your blood pressure which can damage your arteries. Low-sodium means 140 mg or less sodium per serving. Try to keep your meals between 500-700 mg of sodium. less food per portion— This will help you control your weight. more food choices— Variety is the spice of life! The best diet is a mix of healthy foods. more healthy cooking— Ask your rehab team for cooking tips to reduce the fat, cholesterol, calories and salt in your diet. Your rehab team can help you plan your diet. They can also refer you to a dietitian. This is a person with special training in healthy meal planning.


ead all food labels Today, most packaged foods must have a label. If the package is too small, there should be a list of ingredients.

Nutrition Facts

These ingredients are listed in the order of the amount used (highest to lowest). So if sodium or salt is listed close to the top, beware. Think twice about eating that product.

Serving size

When you look at a food label, you will see Sodium under the Nutrition Facts. It will tell you the number of milligrams (mg) of sodium in 1 serving of that product. You also need to see what it takes to make 1 serving. Try to eat only 1,500 mg of sodium per day. Start keeping track. It may surprise you how fast it adds up.

8 servings per container

Amount per serving


2/3 cup (55g)


% Daily Value* Total Fat 8g


Saturated Fat 1g


Trans Fat 0g Cholesterol 0mg


Sodium 160mg


Total Carbohydrate 37g


Dietary Fiber Fat 4g


Total Sugars 12g 20%

Includes 10g added sugars Protein 3g Vitamin D 2mcg


Calcium 260mg


Iron 8mg


Potassium 235mg


* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.


We believe that you have the right


to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

Barbara Johnston Fletcher, RN, MN, FAAN Clinical Associate Professor Brooks College of Health, School of Nursing University of North Florida Jacksonville, FL

Reviewers: F. Stuart Sanders, MD, FACP, FAACVPR, FACSM Clinical Professor Emory University School of Medicine 4 Time Olympic Physician Director, Habersham Cardiac Disease Reversal & Rehabilitation Program Demorest, GA Thanks to our previous reviewers: Jackie Clarke, MEd Robin Gerstler, MS

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