Training Heart Attack Survivors

Over the last 24 years, I have trained at least a dozen men who’ve survived a heart attack, and I’d like to share some of my experience with these men, as well as information from medical authorities.

Please note that I make no reference to being a doctor, but I have raised my skill level to a degree that I welcome all injury rehabilitation into my client base. I also get referrals from local doctors who trust me with their patients!

In this article, I’ll use one of my current clients as an example of the “most” successful survivor I know of to date.

I met Dolph in December of 2009 here on Galveston Island. He is a high-energy newspaper executive. We began training together shortly after we met and continue twice a week. Dolph shared with me how he basically fell dead, from a heart attack, on a running trail in Houston, TX some seven and a half years ago. He lay on the ground for about 4 minutes until help arrived. Dolph made it to the hospital in time. His training goals, seven plus years after his heart attack, are to get stronger, core strengthening and body fat loss.

First let me say that it’s absolutely imperative that any and all trainers know exactly what the doctor has recommended the survivor patient do and not do. Do nothing less and nothing more folks!

After assessing Dolph’s overall strength and conditioning level, we began to do lighter sets of resistance training in the 12 – 20 reps range. As Dolph gained strength and endurance, we increased his workouts to both strength reps of 4 – 6 and lighter weight and high rep sets for flexibility. When you are working with your client, remember to watch them closely — get to know their breathing pattern. A few times, when his breathing wasn’t normal, we’d either stop the session or do 30 minutes.

To Dolph’s credit, he’s not only been able to bench press his body weight of 170, but his best lift to date has been 205 more than once. We do intense sets of Muy Thai punching and speed bag work, also with great success. I always have him walk after each punching set and wait for his breathing to become relaxed. Rope jumping and agility work with a 30 foot ladder are also part of our cross-training in almost every workout.

As the weather warms we’ll also be doing outside work with a 4 x 4 foot parachute for endurance. Dolph’s Vitamin D levels recently got to be dangerously high, (resulting in hypercalcemia), forcing him to miss training for several weeks as he was just too weak.

Once back to training we both found he’d kept his prior strength level at about 90% and regained his endurance quickly. Credit to Dolph (on the right), for training effectively and correctly prior to getting sick. Credit to me for doing “exactly” what his doctor had said also and getting to know his breathing pattern!

Also of interest to this author are the following medical findings: Johns Hopkins Health Alerts states in Types of Exercise for Heart Attack Patients that (1) “Doctors recommend two types of exercise for people who’ve had a heart attack: aerobic cardiovascular exercise and resistance (strength) training. However, any sort of heavy lifting should be avoided until a heart attack patient has been doing cardiovascular exercise successfully for about a month.”

Aerobic Cardiovascular Exercise

Aerobic exercise includes activities such as walking, jogging, cycling, cross-country skiing, rowing, and swimming. Your doctor and the cardiac rehabilitation staff will determine the exact type and intensity of exercise you should do.

Although your initial workouts will likely be at a low intensity level and later ones likely will be more intense, a typical workout may include the following:

  •  about 10 minutes of warm-up (that is, stretching or light walking, jogging, or cycling)
  • 20 to 30 minutes of more intense cardiovascular exercise
  • 5 minutes of cool-down (with activities similar to the warm-up)

Doctors usually request that heart attack patients exercise at least three times a week. To see whether you are exercising with the correct intensity, you may need to take your pulse or use a heart-rate monitor before, during, and after your workout. If your heart rate is not in the recommended range, you need to modify the intensity of your program.

A less-intense exercise program may be more appropriate if you are severely ill, disabled, or frail; have a pacemaker; or take beta-blockers.

Resistance Training

Lifting weights or using resistance machines or bands should be introduced slowly as your health improves. Your doctor may ask you to periodically substitute resistance-training exercise for a cardiovascular workout to help minimize muscle loss.

Ask your doctor or the cardiac rehabilitation staff what amount of weight or resistance to begin with. You will likely start by doing just a few repetitions and gradually build up to three sets of 12 repetitions. You may be asked to increase the amount of weight or resistance you use over time.

We do not give much thought to our heart until something goes wrong with it. Weighing a little less than three-quarters of a pound, it has the Herculean task of pumping oxygen- and nutrient-rich blood through the 60,000-mile highway of blood vessels to all the tissues of the body. Your heart does this nonstop, decade after decade, for as long as you live.

If your physician has diagnosed you with coronary heart disease (CHD), also called coronary artery disease, you are not alone-nearly 17 million Americans suffer from this health problem. CHD is diagnosed when your coronary arteries-the arteries that carry blood to the heart-become narrowed by the buildup of deposits called plaques within the artery walls.

This process, known as atherosclerosis, impairs the ability of the body to pump enough blood through the coronary arteries to provide adequate oxygen and nutrients to the heart. Even worse, formation of a blood clot on top of a plaque can cause a fatal heart attack.

But the good news is that the death rate from and the severity of heart attacks has been declining steadily for many years.

There have been significant improvements in identifying the risk factors associated with heart attacks, and today doctors can choose from a variety of medications to help control high blood pressure, high cholesterol levels, and diabetes. There is also a greater focus on improving lifestyle, with changes like losing weight, exercising regularly, stopping smoking, and eating a low-saturated-fat, low-cholesterol diet.

Overall, the approach has become one of prevention, involving a combination of lifestyle measures, medication, and, sometimes, revascularization procedures like angioplasty or bypass surgery.”

From; (2) “In the hours after exercising, the researchers found, a person’s risk of heart attack increased about 3.5 times, while his or her risk increased about 2.7 times within two hours of having sex. Physical activity also quintupled the risk of sudden death due to cardiac arrest.”

“However, the risk of heart attack or cardiac death was reduced by 45% and 30%, respectively, for each additional workout the study participants completed in a typical week.”

Although the overall (or absolute) risk of heart attack after sex or exercise is “very, very small”, the findings do suggest that sedentary people who want to get in shape should increase their level of physical activity gradually to avoid undue stress on their hearts.” As spoken of already, go slowly with new survivor clients!

Surprise, surprise: it pays to stay active

HealthScout quotes cardiologist Dr Dan Fisher (New York University Medical Center): (3) “If someone has had a heart attack already, it’s not a surprise that exercise is helpful.” Fisher adds that the study did look at a new patient population and confirm the benefits of exercise, according to HealthScout. MI patients need a “whole lifestyle change,” says Fisher, which includes a healthy diet, stress management, and an exercise program, along with proper medications. (4)

CBS HealthWatch quotes another New York cardiologist, Dr Paul Kligfield (Director of the Cardiac Health Center, New York Presbyterian Hospital): “After a heart attack, exercise – when safe – is beneficial. This supports the notion that patients are doing themselves a favor by exercising to their most reasonable capacity.” Kligfield adds, “We often find patients who are not confident in their ability to exercise and are afraid to test themselves a little bit. We also find very often that doctors tell their patients not to do very much. So being in a supervised exercise program after a heart attack can be a very reassuring thing for the patient and the physician.”

From the “best practice” experience of this master trainer, consider the following with regard to heart attack survivor clients:

1. Conduct an in depth assessment in your home file.

2. Watch the client diligently! Watch his or her facial expression and learn what their normal breathing sounds like.

3. Train them slowly with enough intensity that they have a feeling of accomplishment.

4. Ask often “How do you feel?”

Lastly, do not be afraid to train survivor clients. I have found them to be both grateful and faithful to our workouts.



2. By Anne Harding, March 22, 2011 4:02 p.m. EDT


4. CBS Health Watch

About the Author

Bill McGinnis is an NFPT-certified Master Fitness Trainer, and trains exclusively at the University of Texas Medical Branch Alumni Field House on Galveston Island, TX. He has over 24 years in the Fitness Industry, including work as the Men’s Fitness Trainer at the Betty Ford Center and as a Fitness Manager in Southern California. He currently specializes in training older clients for balance, strength, endurance, golf, tennis and an improved quality of life. 


These resources are for the purpose of personal trainer growth and development through Continuing Education which advances the knowledge of fitness professionals. This article is written for NFPT Certified Personal Trainers to receive Continuing Education Credit (CEC). Please contact NFPT at 800.729.6378 or [email protected] with questions or for more information.