Cardiac rehabilitation walking guidelines and programme

Walking is simple, free and one of the easiest ways to get more active, lose weight and become healthier. Sometimes overlooked as a form of exercise, walking briskly can help you build stamina, burn excess calories and improve your heart health. For those who can walk, it has been described as a ‘perfect exercise’. It requires no special equipment and can be integrated into many aspects of routine daily life.

As cardiac rehabilitation professionals, we often get asked questions about starting back walking; this leaflet is designed to give you some advice and information that you might find helpful. Please read this leaflet through before starting your exercises. We hope to provide you with information and advice on starting and progressing your walking. If there is anything you do not understand, seek advice from the cardiac rehabilitation team.

Exercise safety

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

• Your heartbeat 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 if:

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

The benefits of walking

Walking is a type of aerobic exercise, 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. The great thing about it is that just about anyone can do it – anywhere, anytime – and at your own speed!

You carry your own body weight when you walk. This is known as weight-bearing exercise. Some of the benefits of weight bearing exercises include:

• increased cardiovascular and pulmonary (heart and lung) fitness
• reduced risk of heart disease and stroke (opens in a new tab)
• improved management of conditions such as hypertension (high blood pressure) (opens in a new tab), high cholesterol (opens in a new tab), joint and muscular pain or stiffness, and diabetes (opens in a new tab)
• stronger bones and improved balance
• increased muscle strength and endurance
• reduced body fat

When can I start walking?

After a cardiac event or procedure, you may begin walking straight away. If possible start with a short walk, somewhere flat to begin with and close to home or around the home. A short loop around the local neighbourhood would be ideal.

How often can I walk?

You should aim to be active most days of the 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 one or two days, and gradually progress over weeks to do a little more each time. Others may find it appropriate to begin walking every day. Everyone has different goals and starting points, and it may depend on whether you are new to exercise or an experienced exerciser. Health recommendations would suggest we should be trying to achieve 150 minutes of moderate activity per week, but remember that you can build up to this gradually!

How long should I walk for?

The duration and distance of your walks will vary dependent upon the individual and the stage of recovery.

When starting a new activity, begin with a duration that you feel you will be comfortable for you (this may be five to ten minutes for some). You can then begin to increase the duration over time, working towards a total walking duration of 30 minutes. Only once you are able to comfortably maintain walking for a period of 30 minutes should you think about walking for longer periods of time and increasing the intensity of your walk.

It is important that you include a warm-up and cool-down as part of your walk. Your warm-up should aim to be around 10 to 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 increasing the blood supply to the relevant muscles. You should start slowly, and gradually increase the size and speed of your movements.

You should finish your walk with a cool down period of 10 to 15 minutes of low-intensity walking to help your heart rate return to a resting level.

What intensity should I walk 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.

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 your muscles and in 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, you are probably over-exerting yourself and should slow down.

The ideal range to work at to encourage cardiovascular benefits is between the ‘light’ to ‘somewhat hard’ range. If you perceive your exertion as ‘hard’ or any further down the scale from this, you should reduce the intensity of the activity, that is to say reduce your speed or resistance.

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 when walking, you are likely to be working too hard and should reduce the intensity.

Using a heart rate monitor

The conditioning phase of your walk, after a warm-up, should consist predominantly of cardiovascular exercise which raises and sustains your heart rate between 60% and 80% of your predicted maximum (rating your perceived exertion of ‘light’ to ‘somewhat hard’).

If you are unsure about what your training heart rate should be whilst exercising, please speak to a member of the cardiac rehabilitation team.

Using a pedometer

If you are goal-oriented, you may want to consider a pedometer or a smart watch to track just how far you have walked. Pedometers or smart watches are great because they are real motivators. Every step you take is recorded so you can see your progress; after taking a fitness walk, taking the stairs instead of the elevator, or walking somewhere instead of driving, you'll see exactly what you accomplished. You can chart your progress week to week. And, just wearing the pedometer or smart watch can be a reminder to get active.

• 10,000 steps per day is advised by the American College of Sports Medicine (ACSM) to maintain cardiovascular fitness and control weight.
• Office based employees generally accumulate 4,000 to 6,000 steps per day.
• An 18 hole golf course (walking) equates to about 10,000 to 13,000 steps.
• On average, people achieve between 3,000 and 5,000 steps per day.

Getting started

As for any other type of exercise it is important to start with a small amount and build up gradually. You should begin every walk with a very gentle warm-up. This can be incorporated into your walk as the first 10 to 15 minutes, or can be conducted before setting out. When incorporating a warm-up into your walk, start at a very slow, easy pace. During this time, you should gradually increase your speed to a light to moderate intensity.

If possible, start with a short walk somewhere flat, walking at a steady pace. Progress by increasing the distance initially, then you can start to introduce a few hills into your route. Remember that you should finish your walk with a cool-down period of 10 to 15 minutes of low-intensity walking to help your heart rate return to a resting level.

Walking speed will vary from one individual to the next. The important thing to consider is how hard your body is working. Set the speed of your walking at a level where you feel you are exerting yourself at a 'light' to 'somewhat hard' intensity (refer to the RPE scale above).

When progressing your walking, initially try to concentrate on increasing the duration (up to 30 minutes) as opposed to the intensity (speed) of your walking. Remember, moderate intensity exercise is sufficient to bring great benefits to the cardiovascular system. Below is a table which may help you as a guide to progressing your walking duration. Once you are achieving 30 minutes of exercise at a comfortable level, you can then start to slowly increase the speed.

• If you feel you are able to walk for longer than 30 minutes, then you can start at 'Stage 4'.
• Continue at any stage until you feel confident of progressing to the next. The time taken to progress varies between individuals.
• Reassess your progress at the end of each week. Ask yourself, "Is it time for me to move on a stage?" and "Would I feel more comfortable at the same stage for a further week?"

Where can I walk?

If you are interested in walking but do not know any good walking routes around Cambridge, you should check out the following websites:

John Harris's Walking in England (opens in a new tab) has a lot of helpful information about walking in the Cambridgeshire area and may give you some new routes to try out.

Cambridge Ramblers (opens in a new tab) is a Cambridge group which runs a programme of walks, typically in Cambridgeshire and neighbouring counties. The rambles are led by volunteers and range from five to 15 miles.

Walking for Health (opens in a new tab) offers a variety of walks of differing difficulty led by a walking co-ordinator. It is recommended to contact the co-ordinator before attending a walk if possible.

Is your routine getting boring?

We're creatures of habit. It's easy to follow the same path every time we head out. Yet eventually we all get bored with the same route or routine. Here are some tips to help you stay motivated and interested and keep to a life-long exercise routine.

• Change your route; explore a different part of your neighbourhood.
• Head for the country; get out in the countryside and soak in the sounds, smells, and scenery.
• Have a destination; visit someone, to have some refreshment (at a coffee or tea house?), to attend an event, or to shop (don't forget your backpack).
• Plan your routes using John Harris's Walking in England (opens in a new tab). You can plan your route and know exactly how far it is.
• Plan a walking holiday.
• Walk with friends, family or other people.

Nordic walking

Nordic walking is a type of walking which uses poles, similar to those used for cross-country skiing. It is a great exercise which provides an upper body workout as well as a lower body work out. It is a more demanding exercise than regular walking. As a result, if you are interested in Nordic walking, you should contact the cardiac rehabilitation team before participating in order to see if the exercise is suitable for you.

There are a number of Nordic walking groups in the Cambridgeshire area. If you would like more information on Nordic walking, please ask the cardiac rehabilitation team and they can inform you of local groups or instructors.

Walking football

'Walking Football' is a slower-paced version of the game, that aims to encourage all to continue, or start, to play football.

The same rules are as standard expect players are not allowed to run. This makes the game more focused on technical elements. The slower pace makes walking football accessible to all, regardless of age, health and ability.

Helpful tips

We understand that you may find it difficult at times to participate in greater amounts of walking as part of your daily life. Below are a few suggestions of some small changes which you may be able to incorporate into your daily routine:

• Park the car in the furthest car parking space or the next street and walk to your destination. If using a bus, get off at an earlier bus stop and walk the remainder of the journey.
• Walk to the local shops to collect the newspaper and other essentials. On the return journey, imagine being late for an appointment and increase your walking pace, slowing down towards the end.
• Never use the lift or escalator; take the stairs. As your fitness improves take the stairs at a faster pace.
• Take the dog for a walk (borrow a friendly one if necessary!)
• Use activity apps or devices that encourage you to ‘get up’ if you have been sitting for long periods.

Just remember

• Never stop exercising suddenly. Gradually reduce the intensity.
• 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 (work up to 30 minutes) and a cool-down (10 to 15 minutes).
• The ideal range to work at to encourage cardiovascular benefits is between the ‘light’ and ‘somewhat hard’ range.
• Find a walking buddy.
• 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.