JUDY VAN DORP

Congestive heart failure is a growing concern among our aging population, as it is extremely prevalent and very expensive. One out of five people will at some time in their life be diagnosed with CHF. It is the second-leading cause of preventable hospitalizations and the medical cost for a heart failure patient averages $27,000 per year.

CHF results when a damaged or weakened heart is not able to pump enough blood to the rest of the body. Or, more importantly, the heart (pump) does not send blood with enough force for it to return to the central circulation. A weakened heart can be the result of a previous heart attack, untreated high blood pressure or valve abnormalities. Infection, drugs or alcohol can also damage the heart. Heart failure symptoms include shortness of breath, swelling of the hands, feet or abdomen and extreme fatigue.

We are fortunate today to have cardiologists who specialize in heart failure and have many tools at their disposal to improve quality and quantity of life in heart failure patients. Cutting-edge drugs, implantable devices and lifestyle modification are among them.

Lifestyle modification includes improved nutrition, appropriate exercise and maintenance of sound psychosocial health. Taking your medication exactly as prescribed and managing your fluid balance are extremely important in managing the condition. Regarding physical exercise, gone are the days when heart failure patients were advised to “rest.” We now know that activity such as exercise and other activities of daily living are not only safe for most heart failure patients but will likely improve cardiovascular fitness, muscular strength and endurance and overall quality of life. Looking from the health care perspective, we see that structured exercise in the heart failure patient will reduce hospitalizations and treatment costs as well as improve the patient’s survival expectancy and mortality. It is due to these findings that Medicare now covers supervised exercise programs for a targeted population of heart failure patients.

Always seek advice from your health care provider when beginning an exercise program. There may be times when exercise should be avoided, such as when one is retaining fluid, experiencing unusual shortness of breath or experiencing irregular heart rhythms. Once you have been given the go-ahead, here are some things to consider:

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Try to engage in deliberate exercise three to five days per week. If you can tolerate less than 10 minutes of exercise, consider several short bouts of exercise rather than longer periods.

Always incorporate a five-minute warm-up and cool-down routine into your exercise session. This gives your heart time to do what you are asking it to do.

Aim for moderate exercise rather than vigorous exercise. In the exercise world, this means exercising at a heart rate that is 40-60% over your resting heart rate. It might mean walking two miles or biking five miles in 30 minutes. Or it could be washing your car, raking leaves or dancing for 30 minutes. If you can’t talk when you are exercising, you are likely exercising too hard.

Include resistance training in your exercise regimen. It is important to train the muscles in your arms, legs and core. When your muscles are smarter at utilizing oxygen (fuel), you feel much better even if your heart function does not change. Two- to five-pound weights for your arms are a good place to start. Repeatedly standing from a sitting position or shallow squats are great for leg strength. If you choose to use weight machines, lean toward more repetitions at lighter loads. Consider starting with 10 repetitions and working up to 20.

In summary, if you or a loved one have been given a diagnosis of congestive heart failure, it is important to avoid becoming inactive, which will result in weak muscles and worsening shortness of breath and fatigue. The right kind of exercise can help you breathe easier, perform your daily activities with less effort and, most importantly, improve your overall sense of well-being. Although exercise has been proven to be safe for the vast majority of heart failure patients, if you are not comfortable exercising independently, seek the assistance of an exercise professional.

Judy Van Dorp, RN, is the director of the Vidant Wellness Center in Washington and can be reached at 252-975-4236