RX for EX


Regular activity and exercise are two of the most important things you can do daily for your heart health. But how, and how much? On a recent episode of HeartTalk, presented by Captial Cardiology Associates, Dan Myers shared tips on how heart patients can safely stay active. Myers has over 25 years of experience as a certified personal trainer and exercise physiologist. He began his career as the Director of the Coronary Detection and Intervention Center at the 92nd Street Y on the Upper East Side of Manhattan.

In your experience creating exercise requirements for heart patients, where do you start?

It all begins with a review of a person’s Health History. Most heart patients have had a stress test. Based on the results of that stress test, a target heart rate (THR) is generated. The American College of Sports Medicine (ACSM) recommends 60-90% of the maximum heart rate (MHR) comfortably achieved during the stress test. However, other factors need to be taken into consideration.


• The present level of health and fitness
• Orthopedic considerations
• Medications

Individuals who have not exercised regularly need to start slow in the 60-70% range. Whereas someone who has been active, 70-90% is a good THR. It would help if you remembered not only are you going to be overloading your cardiovascular system, your muscles, bones, and connective tissue need to adapt to progressive overload. The biggest mistake is to do too much too soon. Sometimes THR is not appropriate primary due to medications that blunt HR at rest and with exercise. Perceived Exertion is recommended. This number represents your overall feeling of exertion. Not just the way your heart and breathing feel but the way your muscles bones and connective tissue feel. The goal is to be working “somewhat hard” if your overall feeling is comfortable, you are probably not working hard enough. On the other hand, if your overall experience is hard to extremely hard you are overdoing it.

Research shows that if you work extremely hard, you do not get any considerable benefits, and the incidents of a repetitive stress injury increases. If you hurt yourself and you cannot exercise, you have to start all over. So why risk it? Choose an aerobic activity that you like! Try to do it for 30 minutes every day. You should be able to carry on a conversation while you are exercising. If you cannot be overdoing it.

What is an exercise physiologist’s role when working with a cardiologist, nurse, dietician, or primary care provider?

When an individual comes to Capital Cardiology, it is usually because they are symptomatic. Chest pain, shortness of breath, palpitations, syncope. Some are referred to a cardiologist because they have an abnormal EKG, high blood pressure, high cholesterol, all major coronary risk factors. Based on their symptoms, our cardiologist then starts an investigation. The results of this thorough examination are used to make a plan to correct the underlying problem that caused the patient to seek medical attention. The program may require the patient to have intervention such as catheterization, a stent or bypass surgery.

All this information is used by the exercise physiologist to design a safe and valid exercise prescription. The cardiologist decides when it is safe to begin to exercise. Once they have been given the green light, that’s when I take over. Again, it is all about looking at the individual’s health history, the results of any testing they have had. This information along the patient’s goals form the basis of an exercise prescription.

What are some ways to walk for at least 10 minutes per day?

Aerobic exercise requires rhythm contraction of large muscle groups sustained over a length of time. Many heart patients have claudication, cramping of the leg muscles. For those individuals, we recommend walking as far as they can tolerate, stop, sit down and rest, and, when recovered, do it again. Slowly build up to a goal of 30 minutes a day.

How much water should a heart patient drink daily?

The rule of thumb for everyone is to drink eight, 8 ounces of water, daily. For every caffeinated beverage you consume, add two more glasses of water. It is estimated that 60% of our population walk around dehydrated. This can lead to all kinds of health issues. People do not realize that during the night, as we sleep, we lose water through our respiration. One of the best things you can do, first thing in the morning is to drink two glasses of water. Think of it like this: water is a celebration of life. Every time you drink a glass of water, you are celebrating your life. One sign to see if you are drinking enough water: your urine should be the color of lemonade by midday. If it is darker than that you are most likely dehydrated.

What other forms of cardio activity exist outside of running or walking?

There is a principle in aerobic exercise called Specificity of Training. Every time you perform aerobic exercise doesn’t matter what kind of aerobic exercise, there is a central training effect. You are either maintaining or improving your heart, lungs, and circulatory system to deliver oxygen and nutrients to the working muscles. The ability to take the oxygen and nutrients out of the bloodstream is specific to the muscles that are used to perform that form of aerobic exercise. That is why Cross Training is advised. The more variety of aerobic exercise performed, the healthier your entire body gets. This also cuts down on the incidence of repetitive stress injuries. Something else to keep in mind when performing aerobic exercise.

Most cardiac rehab programs focus on 5-6 weeks of building up to a 45-minute walk at least five days a week. Walking, jogging, cross country skiing are all considered weight-bearing exercises because they are performed standing up on your feet. Cycling, rowing is done in the seated position and therefore are non-weight bearing examples of aerobic exercise. This an important consideration, especially for the female population because it helps offset the onset and progression of osteoporosis.

The importance of stretching

There are two categories of stretches, active and passive. Active stretches may be static, dynamic, or ballistic. Passive stretches are normally performed as static or dynamic (as in Proprioceptive Neuromuscular Facilitation).

Types of stretching

• Active Stretch: This happens when the person stretching supplies the force of the stretch.
• Passive Stretch: This occurs when a partner or device provides the force for the stretch.
• Static Stretch: A constant stretch in which the end position is held for 30 seconds. It includes passive relaxation and concurrent elongation of the muscle. It is easy to learn and effective. It does not elicit the stretch reflex of the stretched tissue, and the likelihood of injury is less than if ballistic stretching is used. It helps to relieve muscle soreness and is relaxing when correct methods are used. The sitting toe touch is an example of a static stretch.


1. Get into the starting position of the stretching exercise. Try to stay relaxed during the whole stretch and breath slowly in and out through your nose.
2. Move the body or body segment into the stretching movement (easy stretch) until a mild stretching of the muscle is felt.
3. From the easy stretch position, slowly increase the intensity of the stretch for 10 to 15 seconds. Do not bounce while stretching!
4. Do not stretch so far that pain is felt in the muscle or joint. If this happens slowly, decrease the intensity of the stretch.