Please note

that these recommendations have been produced specifically to help people with, or at risk of, a long term condition, aiming to do moderate activity only.

Angina (Coronary Heart Disease) prescription

Angina and Physical activity

walking in the park

The heart, like any other muscle, needs physical activity to keep it in good condition. In coronary heart disease there is narrowing of the arteries that supply blood to the heart. Physical activity can help protect the health of your heart and help you to reduce your risk of having further problems. Angina is pain that comes from the heart. This can be severe and very limiting for some and only very mild in others. In an unhealthy heart, any extra blood supply cannot get past the narrowed coronary arteries, which causes pain.

Regular physical activity can help with angina symptoms as it helps to improve the blood supply and prevents it from getting worse. Regular physical activity can have a positive effect on risk factors including: high blood pressure, high cholesterol levels (by raising the amount of ‘good’ cholesterol – HDL), diabetes (by gaining better control of blood sugar), having a family history of heart disease, smoking and increased body fat (in particular having lots of fat around the middle).

Regular physical activity also gives you more energy, builds confidence and can help you to sleep more soundly at night. You can combine your activity time with family and friends or use it as an opportunity to reflect on things and listen to your favourite music.

Physical Activity Recommendations for inactive adults with Angina

Aim to do the following three types of activity:
  • Aerobic activity at relative moderate intensity for at least 150 minutes (2 hours and 30 minutes) a week – one way to approach this is to do 30 minutes on at least five days each week.
  • Muscle strengthening activity on two or more days a week which work all major muscles groups (legs, hips, back, abdomen, chest, shoulder and arms)
  • Flexibility exercises on a daily basis
Do not worry if you struggle to meet the Guideline, because by trying to become more active, you are still gaining some health benefits.

The Three Types of Activity and Angina

You may find the following weekly approach useful if you have been inactive for a while.

Aerobic activity

aerobic

Aerobic activity, also known as endurance activity, is when large muscle movements, maintained over a period of time, make the heart and lungs work harder.

Activity type? – Any type that you can maintain comfortably is ideal. Choose exercises that you enjoy, such as walking, cycling or group fitness classes. Aerobic activity is very important for your heart and circulation.

How long (duration)? – You can split your total activity amount into minimum bouts of 10 minutes if needed. If you have been inactive for a long time, start with short daily amounts and increase this as your body allows and you feel more confident. Remember not to sit for hours. A regular break from sitting every hour is healthy.

How hard (intensity)? – Walking is a good way to start if you have been inactive for a long time. Choose a walking distance and speed that you know you can manage easily without getting angina. Make this your target and each time, judge whether the activity was easy or difficult. If it was easy increase the distance but if it was too hard slow down or shorten the distance. You should aim for no more than a relatively moderate intensity activity. The ‘talk test’ is a simple way to measure moderate intensity. This means that you can still talk, but not sing, during the activity.

How often (frequency)? – If you aim to do 30 minutes per day then do this at least 5 times per week so that you reach the 150 minutes total per week. Daily or near daily exercise is better as regular physical activity helps keep your heart healthy. When you start any new activity make sure you give your body enough time to recover and adapt between sessions.


Muscle Strengthening

strengthening

Once your aerobic fitness improves, consider adding strength training on at least 2 days a week. Improved muscle tone can also help you gain better shape and improve the way you look and feel. Stronger, larger muscles use up more calories for energy so it can help you maintain your body fat. Some activities, such as climbing stairs, digging the garden or walking up hill, combine aerobic and muscle strengthening types.

These activities should work all the major muscle groups in your body such as legs, hips, back, chest, abdomen, shoulders and arms. When strengthening a muscle group, begin by familiarising the movement with little or no load.

If you are using weights such as dumbbells, try to do at least 1 set of 8-12 repetitions per activity. The correct weight choice is the one which is hard to complete by the end of the set. A repetition is one complete movement of an activity, like doing a sit up or bicep curl.


Flexibility Exercises

stretching

Daily flexibility exercises can prevent pain, stiffness, and injury of muscles and joints. People often experience a sense of wellbeing and relaxation during flexibility exercises. Some quick and simple movements can be found in our separate exercise sheet. Yoga, Tai Chi and Pilates are examples of some activities which combine strength and flexibility as well as balance training.


Safety considerations

  • If you have led a very sedentary lifestyle, begin by doing low intensity exercise of short duration, e.g. 10 minutes. Increase your level of activity gradually to avoid injury
  • Stop exercising if you feel dizzy, sick, unwell or very tired.
  • See a doctor if you are having chest pain, black outs or breathlessness on mild exertion.
  • Reduce your chance of experiencing angina by warming up at the beginning and cooling down at the end of your activity session.
  • Try to avoid doing physical activity after a heavy meal or in very cold or very hot weather.
  • Cool down slowly as some blood pressure medications reduce blood pressure too much if exercise is ended too quickly.
  • Have your GTN spray or tablet to hand during activity. If you experience angina symptoms, stop and rest until the discomfort passes. Take your GTN medication as instructed by your doctor or nurse.
  • If you are about to do an activity, such has climbing a hill, which you know will bring on your angina then you might want to take your GTN spray or tablet to avoid angina discomfort.
  • If your angina occurs more frequently or you cannot do what you once did then see your doctor as soon as possible.
  • Avoid holding your breath during weight training as this can cause large changes in your BP which could cause you to faint. Avoid heavy weightlifting.
  • Avoid exercises in which the head is lower than the heart as this can raise your blood pressure.

Please see the following safety considerations if you have other long term health conditions.

Disclaimer
This leaflet has been provided for information only. ALWAYS check with your doctor if you have any concerns about your condition or treatment. Prescription4exercise.com is not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this information.
Further reading
  • Start Active, Stay Active – a report on physical activity for health from the four home countries ‘ Chief Medical Officers. UK Department of Health, July 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209
  • ACSM’s Guidelines for Exercise Testing and Prescription, American College of Sports Medicine, 2009
  • Swedish National Institute of Public Health. Physical Activity in the Prevention and Treatment of Disease. Professional Associations for Physical Activity, Sweden, 2010. Coronary artery disease. 283-299. www.fyss.se
Other useful sites

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