One of the ways that people with heart failure (HF) can feel better is to stay active. In the past, people with HF were told to rest and give up many of their common activities. Recent research has shown that normal 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. Walking, light weight-lifting and water workouts are types of activities that will improve muscle strength and energy levels.

Functional capacity is how well a person can perform an activity. The most common way this is described in people 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:

Your health care provider will ask you a lot of questions at each visit about how you carry out activities. Answer these questions frankly so that he or she can know where you are at with your HF and define your NYHA class.

Before you start an exercise program or increase your activity level, talk with your doctor. Your doctor may perform some exercise testing before choosing the best exercise program for you. A Cardiac Rehabilitation program, which is a structured exercise program for patients with heart problems, may be the best option for you. Your blood pressure, heart rate, and response to exercise are watched closely. At the end of the program, an exercise plan is outlined for you.

The goal for most people with HF is to work towards 20-30 minutes of activity per day on most days of the week. You do not have to be active for 30 minutes in a row to gain from exercise. For instance, you can try being active for 10 minute blocks three times during the day.

One thing to know is that the harder the activity, the shorter the time you need to be active to profit from it. If you do a less intense activity, such as working in the garden or light housework, you can do them for a longer period of time.

Strength training, or muscle building is another form of activity that will help you become stronger and improve your lifestyle. . With weight training, you may be able to hold your arms above your head when combing your hair or washing your hair in the shower. A safe way to build up arm muscles is to do stretching exercises using large elastic bands. These can be purchased at many stores. Ask your doctor or nurse where to find these. Another plan is to use soup cans as light hand weights to start building arm muscle. Next, the soup cans may be replaced with 5 pound hand weights.

If you take part in a planned exercise program where you are watched by an exercise expert, you will be asked to rate how hard you feel that you are working during activity. This often takes place in a cardiac rehabilitation program. The most common scale used for people to rate their effort level is the Borg Perceived Exertion Scale. This is a 10 point scale and is listed below.

• 0 - Nothing at all
• 1 - Very light
• 2 - Fairly light
• 3 - Moderate
• 4 - Somewhat hard
• 5 - Hard
• 6
• 7 - Very hard
• 8
• 9
• 10 - Very, very hard

If you are walking on the treadmill at an easy pace and do not feel stressed by the activity, you might rate your effort as a 1. If you walk for a few more minutes and start feeling more stressed but are able to carry on, you might then rate your stress at a 4. The person checking your progress will use this rating to guide your training program and to offer ideas for exercise after you complete the formal program.

Start your activity slowly, more than ever if you have not been active before or if you have stopped being active due to illness. Pick a simple action that you like, such as walking, biking, working in the garden, fishing, bowling and swimming. Walking is always a good first choice because it is easy to find places to walk, both indoors and outdoors. Begin by walking for 5 minutes a day. Then, slowly increase the amount of time you walk each day and the number of days each week.

Be sure to include time to warm-up and cool-down when you exercise. This allows your body to adjust to the exercise and prevents harm or over-stressing your heart. You can try stretching or walking slowly for 5 minutes as a warm-up and cool-down routine. Never stop exercising quickly and then sit or lie down, or stand still. This can make you feel dizzy or faint. Many of the problems that people have with activity occur when they start or stop too quickly.

• Purchase walking 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.
• Always warm up and cool down with stretching and slow walking.
• Do any activity at a slow and steady pace. Avoid activities that require quick bursts of energy.
• Do your activity or exercise at the time of day when you have the most energy. For most people with HF, that is in the morning.
• Exercise with a friend or family member; you may find if easy to stick to your program when you have a partner and you may enjoy it more.
• Do not exercise when you have more shortness of breath than normal, when you feel worn out, when you have a fever or are ill, if you have chest pain or if you are going through a major change in your medication.
• Allow for rest periods during the day between activities. Don’t wait until you are bushed to rest. If you rotate rest times with your activities, you will be able to get more done.

You must watch for signs of being over-tired or over-stressed while exercising. Signs of too much activity include:

• Being so short of breath that you cannot have a chat or say more than a few words while you are active;
• Being so short of breath that it does not get better when you slow down or stop the activity
• 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 you have any of these symptoms while you are active, slow down. If the symptoms do not get better, stop the activity. Call 911 if your chest pain or symptoms do not go away.

Many people with HF often wonder if they can still have sex. The answer is yes. Some people are afraid that sexual activity will hurt their heart or make their HF worse. This is not the case. While sex may not be as easy as it once was, it is safe and can still be a pleasing experience for you and your partner.

People with HF may have problems with sex, such as decreased sex drive, impotence, or failure to climax. Discuss any questions or concerns you may have about sex with your doctor or nurse. Your doctor or nurse may not bring up this topic. Yet, you should feel free to bring it up at any time. Your sexual well-being is good for your well-being and for your bond with your partner. You and your partner should talk frankly about sexual needs and concerns.

As with any activity, you should not have sex if you are feeling ill, are very short of breath, or if you are having chest pain. Pick a time for sex when you feel rested and calm. Avoid sex after a large meal or after drinking alcohol. Use foreplay to help your heart get used to the increased activity and avoid positions in which you must support your weight with your arms. You may need to try out less taxing positions for sex such as lying on the bottom or with you and your partner lying side by side.

If intercourse is too hard for you, try to find other ways to be close with your partner. Find other ways to show love that are pleasing to both of you. Always talk with your partner about each other’s needs and concerns.