Heart Failure and Activity

Active people are healthier than people who are not active. One of the ways that patients with heart failure (HF) can feel better is to stay active. In the past, patients were told to rest and avoid many of their common activities. Recent research has shown that daily activity is safe for most people with HF and may improve symptoms and sense of well-being. By staying active, people are often able to do more of the things that they enjoy. Activities such as walking, light weight-lifting and water workouts will improve muscle strength and energy levels.
Functional capacity is how well a person can do an activity. The most common way this is described in patients with HF is the New York Heart Association (NYHA) Classification. There are four levels of activities and symptoms. The NYHA classes are explained in this way:

NYHA Class I

No symptoms and no limitation in ordinary physical activity.


Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.


Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.


Severe limitations. Experiences symptoms even while at rest.

Your health care provider will check your symptoms at each visit to measure your progress.

Before starting an exercise program, talk with your health care provider to decide what is best for you.

A formal cardiac rehabilitation program for HF may be the best option for you. Your blood pressure, heart rate, and response to exercise are watched closely.

Staying active is one of the best things you can do to improve your symptoms. If easier, you can divide your exercise sessions into smaller blocks of time. Make it a goal to do some activity for a total of 30 minutes every day. Start slowly and increase your activity bit by bit. Do not forget to include both time for warm up and cool down.

Walking is great exercise, but you may also try swimming, dancing, or yoga.

Chose something that you enjoy!

Other ways to add activity into your daily life include:

  • Park at a greater distance to the store
  • Stretch or use a stationary bike or treadmill while watching TV
  • Take the stairs rather than the elevator for a flight

Often, when encouraged to be more physically active, people come up with concerns, worries, or even excuses.   These can be roadblocks, or barriers that can prevent you from taking the first step to exercise. 

  • "I don't have enough time"- We all have the same amount of time, we just use it differently. It is a matter of priorities.  Some people find time for television but not exercise.  Exercise doesn't take a lot of time.  Just 15 minutes a day is a good start, and it is much better than nothing.  If you add 3 10-minute walks, you have 30 minutes of exercise foe the day!
  • "I'm too tired" – When you are out of shape or depressed, you may feel tired.  You must break out of the "too tired" cycle.   Start slow, if you need.  Take a 2 or 5-minute walk.  You may be surprised how even a short walk can give you energy.
  • "I'm too old" – You are neve too old for physical activity.  No matter what your activity level or your age, you can find something to increase your activity, energy, and sense of well-being.
  • "I'm too sick" – Forceful or energetic activity may be too much for you, but you can always find ways to be more active.  Start 1 minutes at a time, several times a day.  Becoming even a little more active can help you cope with your HF and help prevent further problems.
  • "I get enough exercise" – Your job or daily activities often do not provide enough sustained exercise at a level to help you stay physically fit and energetic.
  • "Exercise is boring" – You can make exercise more interesting and fun.  Exercise with other people.  Join a mall walking club or talk to your doctor about enrolling in a cardiac rehabilitation program.  You can listen to music, books, or podcasts.  Change things up!  Change your walking route or your activity.
  • "Exercise is painful" – You may simply need to be less vigorous or change the type of exercise that you're doing.  The old saying "no pain, no gain" is simply wrong.  Talk to your doctor if your pain increases after activity.
  • "I'm too embarrassed" – The options to increase your physical activity range from exercising in the privacy of your own home to joining a group activity. 
  •  "I'm afraid I might fall" – Choose exercises that make you feel safe – chair exercise, water exercise, or a recumbent bicycling can provide a lot of support as you get started.  Strong and flexible legs and ankles and staying active can help with coordination and can reduce the risk of a fall. You may find that using a walking stick, cane, or walker can help you balance.
  • "I'm afraid I will have a heart attack" – In most cases, the risk of a heart attack is greater for people who are not physically active than for those who exercise regularly.  Check with your doctor if you are worried about this.  If your HF is under control, it is safer to exercise than not to exercise.
  • "I'm afraid I won't be successful" – Whatever activity you do – no matter how short or "easy" – will be much better than doing nothing.  The first step is to begin to add some form of activity into your day!

Moderate Exercise

  • Purchase shoes that are comfortable and have good support
  • Wait at least one hour after eating to exercise. You may feel poorly if you exercise on an empty or full stomach.
  • Avoid activities outside when it is colder than 40 degrees F or warmer than 80 degrees F, or on days when there is a lot of smog in the air.
  • Warm up and cool down with stretching and slow walking.
  • Do your activity or exercise at the time of day when you have the most energy.
  • Exercise with a friend or family member.
  • Do not exercise when you do not feel well or have symptoms of more shortness of breath than normal, extreme fatigue, fever, or other illness.
  • Allow for rest periods during the day between activities.

You must watch for symptoms of over-exertion:

  • Getting dizzy or feeling faint;
  • Having chest pain, tightness or pressure;
  • Having pain in your shoulders, arms, neck or jaw;
  • Having skipped hearts beats or really fast or slow heart rate (pulse)
  • Being very tired; and/or
  • Severe sweating, or sickness to stomach.

If these occur, stop immediately and rest as long as needed.

If symptoms persist, call 911.

Why you should get moving

Many patients with HF often wonder if they can still have sex. While sex may not be as easy as it once was, it is safe and can still be pleasing for you and your partner.

HF patients may have issues such as decreased sex drive, impotence, or failure to climax. Discuss any questions or concerns you may have with your health care provider.

As with any activity, you should avoid sex if you are feeling ill, are very short of breath, or if you are having chest pain. Avoid sex after a large meal or after drinking alcohol. Use foreplay to slowly increase your heart rate and avoid positions in which you must support your weight with your arms. You may need to try less taxing positions, such as lying on the bottom or with you and your partner lying side by side.

If intercourse is too demanding, explore other ways to be close with your partner. Quality time doing other things can promote a sense of intimacy and wellbeing for the two of you.

http://www.hfsa.org - accessed on September 9, 2017
http://www.aacvpr.org/ - accessed on September 8, 2017
Medina, M., Walker, C., Steinke, E., Wright, D.W., Mosack, V., Farhoud, M.H. Sexual concerns and sexual counseling in heart failure. Progress in cardiovascular nursing, December 2009.
Pina, I.L. Cardiac rehabilitation in heart failure: A brief review and recommendations. Curr Cardiol Rep 2010, 12:223-229.