How to Exercise Safely when You Have Angina

Angina, or heart pain and discomfort, occurs when your heart isn't getting an adequate supply of oxygen-rich blood.^{[1]XTrustworthy SourceAmerican Heart AssociationLeading nonprofit that funds medical research and public educationGo to source} It can feel like a pain, pressure or tightness in your chest, arms, shoulders or jaw. Angina is a symptom of an underlying heart condition that's triggered when you physically exert yourself to a point where your body can not supply enough oxygen-rich blood to your heart quick enough. This could occur during exercise or even when you're walking up the stairs. However, if your angina is stable, exercise can actually improve your condition. Aerobic exercise helps improve your cardiac health and increases your circulation of that oxygen-rich blood to your heart during rest and activity.^{[2]XResearch source} With your doctor's permission, slowly begin adding exercise safely into your weekly routine to help maintain or even improve your cardiac health.

Part 1

Part 1 of 3:

Staying Fit if You Have Angina

1
Talk to your doctor. Before starting any type of exercise program when you have chronic angina, talk to you doctor. They will be able to give you the clearance to exercise and also give you safety tips.
- Before starting to exercise, ask your doctor if regular physical activity is safe and appropriate for you. Although exercise can help improve angina in many patients, this isn't true for everyone.
- Ask you doctor what types of exercise are best for you. Are you allowed to do cardiovascular exercise? Should those exercises be low intensity or can you do more moderate or high intensity exercises?
- Ask you doctor about what signs and symptoms are dangerous. For example, if you experience chest pain while walking on the treadmill, what should your plan of action be?
2
Track your heart rate during exercise. Tracking your heart rate may be a beneficial practice when you're exercising with angina. It can give you an idea of how hard your heart is working.
- Purchase a heart rate monitor for yourself. You can choose to get a wrist band or watch monitor, however it's best to purchase a chest strap monitor. These are the most accurate.^{[3]XResearch source}
- When you first start an exercise program after being diagnosed with angina, it's typically recommended to do low intensity exercises that keep your heart rate at about 50% of your maximum heart rate.
- To find your maximum heart rate, subtract your age from 220. For example, if you're 60 years old, your maximum heart rate would be 160 beats per minute.
- Using your heart rate tracker, keep you heart rate right at 50% during your exercise routine. In this example, you'd aim for your heart rate to be around 80 beats per minute.
- If cleared by your doctor, you can slowly build up your aerobic endurance and increase to 60 or 70% of your maximum heart rate. However, don't aim to reach your max heart rate during exercise.
- People with angina can adapt to exercise in a way that allows them to improve their exercise performance. Sometimes, you can take nitroglycerin to improve your exercise performance, but also, sometimes the exercise by itself helps you adapt.
3
Consider starting with a cardiac rehab program. If you have been just diagnosed with angina, your doctor may suggest attending a regular cardiac rehab program. These are great medically supervised programs that can help you get back into regular exercise.
- A cardiac rehab program is provided on an outpatient basis to those who have suffered from a cardiac event or have chronic cardiac conditions. They are designed to help improve fitness levels while reducing symptoms and side effects.^{[4]XTrustworthy SourceAmerican Heart AssociationLeading nonprofit that funds medical research and public educationGo to source}
- Talk to your doctor about going to a cardiac rehab program to help improve your aerobic endurance, physical strength and range of motion.
- Stick to your cardiac rehab program until you are cleared and released for exercise on your own. Follow up with your doctor regularly and stay on top of your cardiovascular health.
4
Start with short bouts of low intensity exercises. Many people that have angina, are at lower fitness levels. This may especially be true if you've been required to take several weeks or months off from your exercise routine when you were initially diagnosed.
- If you are trying to recover and rebuild your cardiac strength and endurance, it's recommended to start with short bouts of lower intensity exercises.^{[5]XResearch source}
- Restarting with higher intensity exercises, or trying to go for a longer period of time could cause symptoms to reoccur or for your condition to get worse.
- Aim to start with just 15-20 minutes of low intensity activity each day. If this feels too easy, increase the time to 25-30 minutes the next day, but do not increase the intensity.
5
Choose exercises that are low in intensity like walking, water walking, cycling or using the elliptical.
- As your endurance gets better and your fitness improves, you can very slowly increase first the length of your exercises and then the intensity as well.
- These exercises can increase your heart rate, but you are in full control of how high your heart rate increases during your exercise routine.
6
Always include an extended warm-up and cool-down. Warm-ups and cool-downs have always been considered an important component of any exercise routine. However, both become even more essential to safe exercise.
- Slowly easing into and out of an exercise routine helps slowly increase your heart rate, blood flow and warm up your muscles. Both can also help prevent injuries.
- When you have angina, warming up and cooling down your heart is essential. If you don't, you can overwork your heart too quickly which could cause an onset of symptoms.
- Give your body and heart time to adjust to higher levels of activity. Start with a minimum of a 10 minute warm-up. Include very low intensity aerobic exercises and light stretching.
- Also allow your heart to slowly cool down and your heart rate to slow as well. Your cool-down should also be 10 minutes of low intensity aerobic exercise followed by some light stretching.
7
Avoid exercising in extreme weather conditions. Another aspect to safe exercise when you have angina is avoiding extreme weather conditions.^{[6]XResearch source} You may be surprised how much the outdoors can effect your condition.
- It's recommended to avoid exercising outdoors if it's overly cold, hot, or humid weather conditions.
- Being active in these types of weather increase your risk for experiencing a cardiac event.
- If you want to stay regular and consistent with exercise during more extreme weather, move your workout indoors. Walking on the treadmill, using an indoor pool or doing a aerobic DVD inside are great alternatives.
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Part 2

Part 2 of 3:

Meeting Exercise Needs with Angina

1
Start by aiming for 150 minutes of aerobic cardio each week.^{[7]XExpert SourceShervin Eshaghian, MD
Board Certified CardiologistExpert Interview. 26 June 2020.} You may feel that because you have angina, that your total activity should be limited. However, as long as your angina is stable, you should be able to fit in about 150 minutes of cardio activity each week.
- Health professionals note, that as long as your angina is stable and you have clearance from your physician, meeting the recommended activity goals each week is a safe goal.
- It's recommended to aim for about 150 minutes of aerobic activity each week. Split this activity up into shorter bouts (especially if you're just starting). Try for 20 minutes 6 days a week. Or you can even do three 10 minute sessions 5 days a week.^{[8]XTrustworthy SourceCenters for Disease Control and PreventionMain public health institute for the US, run by the Dept. of Health and Human ServicesGo to source}
- Start with lower intensity exercises like walking or water aerobics. However, overtime, if you can, build up to more moderate intensity activities like hiking, slow jogging, using the elliptical with resistance or doing an aerobics class.
2
Slowly add in low intensity strength training. In addition to cardiovascular exercises, it's important to work on improving your muscular strength. Resistance or strength training will complement your aerobic work.
- Health professionals also agree, that most strength training activities are also appropriate for you to do even if you have angina.
- Aim to include about 20 minutes 1-2 times a week of muscle building exercises. You can try weight lifting, yoga or pilates.
- Note that you my want to limit upper body exercises as these have been shown to cause angina more than lower body exercises.^{[9]XResearch source}
3
Include more lifestyle activity. In addition to focusing on including more structured exercise, also increase your lifestyle activity. This is a great way for angina patients to stay active and safe.
- Lifestyle activities are those exercises that you do on apart of your regular daily life. This might be walking to get the mail, taking the stairs, gardening, mowing the lawn or sweeping the floor.
- They do not burn a lot of calories or spike your heart rate. However, they do keep you active and moving and elevate your heart rate mildly enough that you can still see aerobic benefits.^{[10]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
- Many studies have shown that structured aerobic activity and increase lifestyle activity have very similar health benefits. So if you cannot do a lot of structured activity or cannot sustain activity for long, try increasing your lifestyle activity first.
4
Always include rest days. Although being active on a regular basis is important to regaining your aerobic strength, it's still important to include regular rest days.
- Health and fitness professionals recommend that you include about one or two rest days each week. If you're just starting with exercise, you may include up to three days a week.
- Rest is important for a variety of reasons. For starters, it's during rest that you improve muscle strength, see increases in muscle size and aerobic endurance.^{[11]XResearch source}
- Rest is also important for those suffering from angina because you need to allow your heart and cardiovascular system to rest and recover in between workouts.
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Part 3

Part 3 of 3:

Staying Cautious While You Exercise

1
Stop if you experience any pain or discomfort.^{[12]XExpert SourceShervin Eshaghian, MD
Board Certified CardiologistExpert Interview. 26 June 2020.} Many health professionals recommend exercise to help recover if you have angina. However, they also recommend that you be mindful of symptoms.
- If you feel any type of chest pain, difficulty breathing or tightness in the chest, stop exercising immediately.^{[13]XResearch source}
- After you discontinue your exercise, keep your heart rate level low. Do not restart exercise even after the pain or other discomfort has subsided. You should take a rest day.
- If you notice any pain or discomfort the following day or at your next exercise session, contact your doctor immediately.
2
Always carry your medications with you. There are a variety of medications that are prescribed to manage angina. Always carry these with you - especially when you're exercising.^{[14]XResearch source}
- One of the most common prescription medications that are prescribed for those with angina is nitrogen glycerin. It's to be taken when you start to experience any symptoms. This is essential to have on you at all times.
- Also, make sure that others know of your condition and where your medication is. If you were to have any symptoms and couldn't get to your medications, someone else should be able to help you.
3
Consider bringing someone with you while you exercise. Another great idea to keep you safe during exercise, is to have someone with you. They can help treat any symptoms or serious issues that arise if you are unable to.^{[15]XResearch source}
- Although scary to think about, symptoms can occur even if you are being treated for angina. Symptoms are generally mild, but some can be more serious and life threatening.
- Since exercise can precipitate symptoms, consider bringing a friend or family member with you as you exercise. They should be someone who is familiar with your condition, medications and know what to do if an emergency arises.
- Try to go to the gym together, go for walks together or bike ride together. Having someone there just in case can make exercise safer and you feel more confident.
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Should I exercise if I have chest pain?
Shervin Eshaghian, MD
Board Certified Cardiologist
Dr. Shervin Eshaghian is a Board Certified cardiologist and the owner of Beverly Hills Cardiology based in the Los Angeles, California metro area. Dr. Eshaghian has over 13 years of cardiology experience, including serving on the medical staff at Cedars-Sinai Medical Center. He holds a BS in Psycho-Biology from the University of California, Los Angeles (UCLA) and an MD from the Albert Einstein College of Medicine. Furthermore, Dr. Eshaghian completed an internship, residency, and fellowship at Cedars Sinai Medical Center, where he was awarded the Leo Rigler Outstanding Academic Achievement Award and the Elliot Corday Fellow of the Year Award.
Shervin Eshaghian, MD
Board Certified Cardiologist
Expert Answer
If you're in the middle of your workout and you start feeling pain in your chest, you should stop what you're doing and let your heart rate return to normal.
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Tips

Although angina is a manageable condition, it's still a very serious heart condition. Never participate in exercise unless you've been cleared by your physician.
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If you notice an increase in symptoms, call your doctor immediately.
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Don't be afraid to exercise if you have angina. Regular exercise can actually help improve your heart health.
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