Cardiac rehabilitation cycling programme

As cardiac rehabilitation professionals we often get asked questions about cycling so here is some advice and information that you might find helpful.

Please read this leaflet through before starting your exercises. If there is anything you do not understand seek advice from the cardiac rehabilitation team before starting the exercises.

Exercise safety

You should not start exercise and should contact your cardiac rehabilitation team or GP if:

• Your heart beat feels irregular and this is new to you.
• You feel unwell, have a fever or any other temporary illness.
• Your heart rate is much faster or slower than is normal for you.
• You have new or recurrent symptoms of breathlessness or angina.
• You feel unusually tired/ fatigued.

You should stop exercise immediately keeping the feet moving gently if:

• You feel light headed, dizzy or faint.
• You feel chest pain (angina).
• Your breathing becomes uncomfortable.
• Your heart beat becomes irregular.

Exercise for your heart

Regular exercise training is an important part of your recovery and long term prevention from a cardiac event.

Exercise can reduce your risk of future cardiac events, reduce your risk of cardiac mortality and hospital admissions from cardiac causes, but also has benefits on reducing risk of many other conditions including (but not limited to) cancers, diabetes, mental health problems, musculoskeletal and joint pains, high blood pressure and high cholesterol and osteoporosis.

It is important however to exercise in a safe way to reduce the risk of injuries, angina and arrhythmia (abnormal heart rhythms), and this information outlines the key principles to follow when exercising in your own time. You have been provided with this leaflet as you have expressed an interest in cycling as a form of exercise.

Why is cycling good for me?

Cycling is a type of aerobic exercise, like walking or swimming, which promotes the pumping effect of the heart and helps it to work more efficiently. It is also a great activity for improving your fitness levels and general wellbeing.

Additionally, bike riding has none of the joint shock, from continuous impact with the ground, which occurs with some other aerobic activities such as jogging. Because cycling causes less wear and tear on the joints and muscles and yet still delivers a good cardiovascular workout, it's a good option for individuals with joint problems.

When can I start cycling?

The time you need to wait to start cycling will vary between individuals. If you were a regular cyclist before your cardiac event, you may be able to return to cycling sooner, but as a general rule, after a heart attack you should wait around 4 weeks to cycle on the roads, but this may be reduced if using a static cycle at home.

Individuals who have had open heart surgery (bypass or valve), may need to wait longer (8-12 weeks), until all their wounds are healed and the breast bone is stable. However, it is still important to remember that these are just guidelines and healing time may vary from person to person. You should only begin to cycle when your wounds are healed and you feel ready. You may be able to use a static cycle sooner after surgery but delay using your bike on the road for up to 12 weeks post-surgery.

If you have had a pacemaker or implantable cardioverter (ICD) you should wait at least 6 weeks after device fitting, but again potentially a static bike could be used sooner in some circumstances. For an ICD it is recommended to have your first check prior to completing any harder intensity exercise.

As with all the advice above this is generalised. Please consult with the Cardiac team or attend for an exercise assessment for individualised advice.

How often can I cycle?

You should aim to be active between 3-5 days per week. For those individuals who feel like they cannot manage to be active most days of the week, then you may wish to start with just 1-2 days and then gradually progress over the weeks to do a little more each time. Others may find it appropriate to begin with the full 5 days. It is also important to have some rest, particularly early in your recovery and so it is recommended to have 2 days off from your exercise each week, or 2 days including only light exercise. This will give your body the time to regenerate your energy stores. Realistically, maybe you can only fit in one 30 minute ride a week, but something is better than nothing.

How long should I cycle for?

Inside or outside, it is important that you include a warm up and cool down as part of your cycle. Your warm up should aim to be around 15 minutes in duration. The aim of the warm-up is to gradually raise your heart rate whilst gently loosening up your main joints and muscles, and increasing blood flow to the working muscles. You should start slow and gradually increase the intensity. The warm-up can be done separately or on the bike itself. The benefit of using the bike is you are using the same muscles as you will use during the exercise component. To warm up on the bike start with a slow pace and low resistance, and gradually increase this over 15 minutes to a light to moderate intensity (see below).

The duration of the conditioning phase will vary depending on the individual and the stage of recovery you are at. When starting a new activity, begin with a duration that you feel you will be comfortable with (this may be 5-10 minutes for some). The warm-up does not count towards this total time. The warm-up should always be undertaken and to progress your exercise you can begin to increase the duration of the conditioning phase, working towards a total duration of 30 minutes. Only once you are able to comfortably maintain cycling for a period of 30 minutes should you think about cycling for longer periods of time. How fast or the distance you cycle will vary person to person. Try not to focus on these things initially but instead focus mainly on the intensity or how the exercise feels (see below)

Finish your cycle with a cool down period of 10 minutes, gradually lowering the intensity of pedalling to help your heart rate return to a resting level. If you stop cycling suddenly, you may begin to feel lightheaded because blood can pool in the legs. As an alternative to low-intensity pedalling, get off your bike and walk to cool down.

If your fitness only allows you to do a shorter session, then still try to start slower (for 5 minutes) and finish slower (for 5 minutes).

What intensity should I cycle at?

When participating in any activity it is important that you are able to rate how demanding or strenuous that particular activity is for you. This is called ‘Rating your Perceived Exertion (RPE)’ and is a very good tool for keeping the intensity of your activities safe but still appropriate for you to benefit from these.

When rating your exertion you should think of how the entire body is feeling at that moment in time. Think of the strain and fatigue in both your muscles and your breathing. If your muscles are aching and feel very heavy, you are likely to be working at a hard intensity and should ease off slightly. If you find your breathing becomes uncomfortable and it is difficult to catch your breath, you are probably over exerting yourself and should slow down.

The ideal range to work at, during the conditioning phase, to encourage cardiovascular benefits is between the ‘light’ to ‘somewhat hard’ range in the early stages. If you perceive your exertion as ‘hard’ or any further down the scale from this, you should reduce the intensity of the activity i.e. reduce your speed or resistance. As you progress you may be able to progress to working at a ‘hard (heavy)’ level. Please discuss this further with one of the Cardiac Rehabilitation Exercise Physiologists.

RPE Scale

6 - No exertion at all

7 - Extremely light

8

9 - Very light

10

11 - Light

12

13 - Somewhat hard

14

15 - Hard (heavy)

16

17 - Very Hard

18 - Extremely hard

19 - Maximal

20

At a ‘light’ to ‘somewhat hard’ intensity you should feel warm, possibly slightly sweaty and your breathing should be deeper and faster. You should still be able to talk. If you are struggling to talk during activity, you are likely to be working too hard and should reduce the intensity.

It is beneficial and safe to be slightly out of breath when cycling but you should be able to talk. If you are uncomfortably short of breath, then you should try to reduce the intensity by slowing the pace, resistance or avoiding hills. If you continue to be uncomfortably short of breath, even on flat surfaces at slow speeds, then cycling is not the best type of exercise for you at this time.

Using a heart rate monitor

The conditioning phase should consist predominantly of cardiovascular/ endurance based exercises which raise and sustain your heart rate between 60% and 80% of your predicted maximum, which equates to rating your perceived exertion of ‘light’ to ‘somewhat hard’.

We would recommend speaking with a member of the Cardiac Rehabilitation team to determine an appropriate Heart rate zone for yourself. Certain medications may affect your heart rate and so it is important you seek assistance if you are unsure about what your training heart rates should be to avoid over-working and under-working.

Getting started

Before using a bicycle you should consider the following points:

• Seat height

Stand by the side of the bike and adjust the seat height to be level with your hip bone. Once on the bike push one pedal down to the lowest point. At this point your leg should be slightly bent (at a two degree to five degree angle).

• Gripping the handle bars

Be sure not to grip the handle bars too tightly. This will result in greater increase in your heart rate and blood pressure.

• Gears

Keep the gears low to start. The added resistance from the gears will also raise your heart rate and blood pressure.

As is the case with any type of exercise it is important to start with a small amount and build up gradually. If possible start with a short ride, somewhere flat to begin with, pedalling at a steady pace. Progress by increasing the distance, then you can start to introduce a few hills into your route. If you have a bike collecting dust in the garage or shed dust it off and have a go.

Where can I cycle?

If you are interested in cycling but do not know any good cycle routes around Cambridge, you should check out the Cam Cycle Resources (Map) website (opens in a new tab).

It has a lot of helpful information about cycling in Cambridgeshire and may give you some new routes to try out.

Helpful Tips - Indoor

• If you like to exercise at home, get a stationary bike or an indoor mount for your outdoor bike. If you are concerned about your balance, a stationary bike can provide you with the opportunity to exercise without worrying about balancing your bike.
• Schedule a specific time to cycle indoors.
• Watch movies or TV while cycling. Before you know it you will have been exercising for 30 or 60 minutes.

Outdoor Tips

• Wear a helmet
• Plan your route in advance.
• Avoid busy roads and heavy traffic. This is not meant to be stressful. Look for scenic bike trails or quiet roads within your neighbourhood.
• Wear bright reflective clothing.
• Have at least one reflector on your bike - the best place for reflectors is on the back of your pedals.
• Drink plenty of fluids (take a bottle of water with you)
• Be aware that exercising in extreme weather (very hot, cold or windy) will increase the stress placed on the body, so you may need to reduce your intensity.

Just remember

• Initially you should keep exercise sessions short and intensity levels low; increases should be gradual.
• When performing an activity you should always include a warm up (15 minutes), a conditioning phase (build up to 30 minutes) and a cool down (10 minutes). Never stop exercising suddenly. Gradually reduce the intensity
• The ideal range to work at to encourage cardiovascular benefits is between the ‘light’ to ‘somewhat hard’ range.
• Have a cycling buddy if possible. This can increase your motivation to stick to an exercise routine
• Do not eat or drink alcohol immediately prior to cycling. Have a meal 2-3 hours prior or a light snack in the 2 hours prior to exercising.
• Stop exercising and alert a clinician if you experience pain or shortness of breath.
• Have Fun!

If you are unsure about any exercise or information within this document, please contact a member of the cardiac rehabilitation team on 01223 216985.