Is Walking Good for Congestive Heart Failure Patients?

Walking is one of the best and easiest forms of exercise for people with congestive heart failure (CHF). Years ago, healthcare providers advised patients to avoid working out, but that's no longer the case. A 2018 study showed that regular, moderate-intensity walking can also prevent heart failure in people with heart disease.

Walking has numerous benefits for patients with heart failure, but as with all new exercise programs, you should check with your healthcare provider for guidelines on any precautions you should take.

Walking to Strengthen Your Heart

Physical activity is important for heart health. Walking is one of the most popular forms of exercise and provides numerous benefits to your heart when you have heart failure.

A 2013 study in patients with chronic systolic heart failure showed that moderate levels of exercise could reduce subsequent risk by approximately 65% for cardiovascular mortality or heart failure hospitalization.

Walking is an aerobic activity. Aerobic exercise makes your heart beat faster and makes you breathe harder. Both of these actions strengthen the heart. Walking helps congestive heart failure patients in several ways:

• Reduces heart attack risk, including cutting the risk of having a second heart attack.
• Strengthens their hearts and improves lung function. Long term, aerobic activity improves your heart's ability to pump blood to your lungs and throughout your body. As a result, more blood flows to your muscles (including your heart muscle), and oxygen levels in your blood increase.
• Reduces the risk of developing other factors for heart disease by lowering blood pressure, increasing HDL (good) cholesterol, and keeping insulin and blood sugars in check, thereby reducing the chance of developing diabetes.
• Assists in attaining and maintaining a healthy weight, keeping obesity and overweight at bay. Exercise burns calories and fat and builds muscle. Too much weight strains the heart, and obesity is an independent risk factor for heart disease. 

Other Walking Perks

Additional benefits you can get from walking include:

• Better sleep: Exercise can help you fall asleep more quickly and get more deep sleep. It doesn't take long: People who exercise for 30 minutes may see a difference in their sleep quality that night.
• A mood boost: Exercise can reduce stress, tension, anxiety, and depression.
• Improved self-esteem and body image: You will look and feel better.

If you've had a cardiac event, such as a heart attack, your healthcare provider may recommend walking as part of your cardiac rehabilitation program. Everyone recovers at a different pace, but cardiac rehab is worthwhile. People who participate in cardiac rehab have a faster and safer recovery and better outcomes post heart attack.

A 2015 study showed improvements in fitness during cardiac rehabilitation resulted in decreased mortality even at one year, which held true in study participants who started rehab in the lowest fitness group. 

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General Guidelines for CHF Patients

The American Heart Association has established physical inactivity as a modifiable risk factor for heart disease, however only 17% of patients with self-reported coronary heart disease perform the recommended levels of physical activity.

The U.S. Department of Health and Human Services recommends the following exercise guidelines for meaningful health benefits:

• Adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity,
• Or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.

There are special, additional recommendations for older people and those with chronic conditions:

• Older adults should consider their level of effort for physical activity relative to their fitness level.
• Older adults with chronic conditions should understand if and how their health status affects their ability to do regular physical activity safely.

Remember, if you're unable to do 150 minutes of moderate-intensity aerobic activity a week because of your heart failure, walking a little is better than doing nothing. You can start with 5-10 minutes per day at a slow pace and add time and speed as you get stronger.

It's best to always speak to your healthcare provider before beginning an exercise program. Your healthcare provider will be your best guide to determine how much and how intensely you can walk or do other types of exercise.

Getting Started

All you need to get started walking are comfortable clothes and supportive shoes. Layering your clothes is a good idea because doing so can keep you cool when your body temperature rises during your work out. Shoes designed for walking or running are best, but not essential.

Generally speaking, your workout should consist of a warm-up, conditioning, and cool-down.

• Warm-up: Warm-up about 5-10 minutes. Taking this important, initial step helps your body get ready to workout, reduces stress on your heart and muscles, and helps prevent sore muscles. A warm-up should include stretching and walking at a low-intensity level.
• Conditioning: This phase should last 20-30 minutes and consists of walking at your chosen intensity level. During this time, you are burning the most calories and actively exercising.
• Cool-down: This phase should last about 5 minutes. It helps your body recover from your workout, allowing your heart rate and blood pressure to return to normal slowly. During this phase, you can decrease your exercise intensity and do some of the same stretching you did during your warm-up.

Do not sit down without cooling down. This can make you feel dizzy or have heart palpitations (when your heart skips a beat). Stretching at the end of your walk is an ideal time since your body is warmed up. Stretch your hamstrings, calves, chest, shoulders, and back. Hold each stretch for 15 to 30 seconds.

Here are some additional walking tips:

• Start gradually: If you’re out of shape, begin with short distances. Start with a comfortable pace and gradually increase your time or distance. Trying with several 10- to 20-minute walks a day instead of one long walk is one way to make it easier.
• Watch your form: Keep your head lifted, abs engaged and shoulders relaxed. Swing your arms naturally. Avoid carrying heavy items (more than 10 pounds) or hand weights because they can put extra stress on your elbows and shoulders. Try to walk naturally.
• Breathe: If you can’t talk or catch your breath while walking, slow down. Speed isn't so important in the beginning. 
• Step up the pace: Walk at an easy pace for the first several minutes. Then gradually increase your speed.
• Change it up: Try brisk intervals. For example, walk fast for a few minutes then, slow for a few minutes and repeat several times. Over time you’ll be able to add more fast intervals with shorter recovery periods. If you are already active or have a higher level of fitness, you may be able to walk up hills or other inclines to increase the intensity.

Fit walking into your schedule whenever you can. That may mean three short walks a day. When you are able, longer walks will help you boost your stamina.

You can also sneak in more steps by parking farther from the door when you're running errands, marching in place while waiting in line, walking around the house, or taking your dog for a walk. Just remember, your overall goal is to get as close as you can to meeting the 150 minutes of activity per week.

Risks

Generally, the benefits of walking for exercise outweigh the risks to your heart. It is rare that physical activity would create heart problems. The risk of heart problems during exercise correlates to your fitness level. Meaning that if you intensely workout with heart failure, but aren't fit, your risk of having a heart attack during the workout is higher and vice versa.

Having congestive heart failure means you need to be cautious about when and how intensely you exercise. Some instances that may signal you should avoid exercising include:

• If you feel more short of breath than usual
• If you feel very tired
• If you are sick or have a fever
• If you are making major medicine changes

If these symptoms are persistent, you may want to check in with your healthcare provider.

Other Heart-Healthy Exercises

Walking is great exercise for congestive heart failure patients, but there are other options, too:

• Low-impact aerobic exercises such as cycling, dancing, swimming, or water aerobics are great ways to work your heart but are also easily modifiable to accommodate your fitness level and health restrictions.
• Stretching: Stretching and flexibility exercises involve slow movement to lengthen the muscles. Stretching before and after walking helps prevent injury and strain. Other benefits include better balance, range of motion, and better movement in your joints.
• Weight training: Muscle-strengthening activities improve the strength and endurance of your muscles. Doing push-ups and sit-ups, lifting weights, climbing stairs, and digging in the garden are examples. Study shows that combining strength training with your walking workout offers additional, unique heart benefits than doing aerobic exercise alone.
• Mindfulness activities, such as yoga and tai chi, can improve flexibility, mood, and stability, lower stress, and motivate you to exercise more and eat healthier. The mindfulness movement has gained steam in the last decade. Books, videos, and online information are readily available about ways to incorporate mindful activities into your life.

A Word From Verywell 

Walking may not be as vigorous as other types of exercise, but research shows it is equal to all different types of exercise in terms of lowering heart failure risk. Speak to your healthcare provider about tailoring a walking workout to your level of fitness that considers your heart failure limitations.