Woman making heart shape with hands

Your heart is a muscle that pumps blood throughout the body, making it an extremally important organ. Heart problems can be dangerous and even deadly. In fact, heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC).

Heart disease refers to a few different conditions, but the most deadly type in the U.S. is coronary artery disease. If you have coronary artery disease, you’re at a much higher risk for heart attack, which can be fatal. To reduce your risk for heart disease, diet and exercise are both important. Medication can help as well, but a strong foundation of proper diet and exercise goes a long way. However, some people with heart problems need to avoid certain types of exercise. Either that, or they need to adjust how intense their workouts are.

A doctor or cardiac rehabilitation specialist can help you figure out what exercises are appropriate and what you need to avoid. In the meantime, here’s a list of exercises you may want to incorporate into — or omit from — your fitness routine if you have heart problems.

Do: Walking

Person walking outdoors holding cane

To some, walking might not seem like a form of exercise, but if you have heart problems, the safest option is to start slow.

Unless you have balance problems and are prone to falling, walking is a healthy way to get into a workout routine. An article from Intermountain Healthcare lists walking as a highly recommended exercise to strengthen your heart.

If your normal walking pace feels too slow, feel free to try speed walking. Pick up the pace, or find a hill or stairs to climb to make your walk more intense. Walking elevates your heart rate and has very little impact on your joints, especially when compared to jarring exercises like running. The only equipment you need? A pair of comfortable walking shoes and the right clothing for the weather you’re walking in. You can also use a treadmill in the gym to walk, which makes it easy to adjust your speed and incline.

Avoid: Sit-ups

Woman performing situp exercise

It might seem natural to avoid using weights and start with bodyweight exercises instead. While some bodyweight exercises are safe for people with heart problems, others can be dangerous. A sit-up can be dangerous, according to National Jewish Health. Experts at the site also warn that you should avoid push-ups. For some people, a push-up is easy and might be safe, but for most people, it causes a lot of strain and can be dangerous.

On the other hand, people without heart problems may want to indulge in some bodyweight exercises. A study published in Clinical and Experimental Hypertension looked at the effects of bodyweight workouts in middle-aged adults with high blood pressure. The researchers had the participants do inverted rows, squats, and sit-ups, all without weight. They found that after the workouts, people who did the bodyweight exercises had lower blood pressure on average than people who didn’t exercise. This means that people with high blood pressure should consider doing bodyweight workouts.

Do: Swimming

Athletic person swimming laps in pool

On a warm day, taking a dip in the ocean or floating in a pool can be relaxing and cool you down. Swimming can also be a useful form of exercise for people who have heart problems, says Intermountain Healthcare. You use your arms, legs, and core muscles when you swim, making it a full-body workout. It’s also very low impact, so people with joint problems who have trouble moving can use swimming to strengthen their muscles.

If you don’t know how to turn swimming into a workout, try attending a water aerobics class, or seek out a swim instructor who can help you swim laps. Swimming has other benefits, explains the CDC. People with arthritis (who tend to find many movements painful) have demonstrated that they received health benefits from swimming. Water-based exercise also helps improve quality of life in older people and decrease disability, so if you have heart problems and other movement-related problems, swimming can help.

Avoid: Isometric exercises

Man holding plank position

When you hold a weight in one place rather than moving it through a range of motion, you’re doing an isometric exercise. The National Academy of Sports Medicine says that isometric exercises are also known as static exercises, and they typically involve more than one joint. A plank is an example of an isometric exercise because you’re contracting muscles to maintain your position, but your body isn’t moving.

Whether you’re doing a bodyweight exercise or something with added resistance, you should move through a range of motion and do multiple reps. A study published in the American College of Sports Medicine’s Health and Fitness Journal explains that when you do a sustained isometric hold, your blood pressure can increase. This is bad news for people with heart problems. However, they recommend proper resistance training as something that can benefit your heart, so don’t shy away from all forms of resistance exercise.

Do: Exercises with weight machines

Man on leg extension machine

Lifting weights is helpful for people who have heart problems, as long as it’s done properly and with the correct equipment.

You can do resistance exercise with free weights, but for some people, resistance training machines are preferred. For people who are dealing with other health problems, weight machines are particularly useful. For example, a study published in the American College of Sports Medicine’s Health and Fitness Journal says that machines are better for people who have balance issues.

Another benefit of machines is that they make exercises easier perform, and can save you time in the gym. If you’re new to exercise, learning a movement on a machine can be easier because they guide you through a range of motion. Free weights can be more advanced, and therefore take longer to learn. Machines also stabilize the body, making it easier to focus on the specific muscles you’re trying to work.

Avoid: Lifting heavy weights

Woman with heavy weight on back

There’s conflicting advice given by the medical community surrounding weight training recommendations after heart attack or other heart issues, says a 2006 study published in Baylor University Medical Center Proceedings. They cite patients whose doctors told them not to lift anything over 10 pounds for a while after having a cardiac event. However, many doctors prescribe aerobic exercise (such as walking) instead of weight training.

In the 2006 paper, the researchers argue that people lift weights all the time, in the form of objects such as a laundry hamper or pulling a car door open. Therefore, they should lift weights as part of the rehab process. They recommend using lighter weights and high reps. Earlier studies on weight lifting in heart patients showed that using weight above 70% of someone’s one rep max weight was dangerous. That’s due to the increase in blood pressure and holding the breath while lifting, which can happen when using heavy weights.

Do: Bodyweight lunges

Woman performing bodyweight lunges

Some bodyweight exercises can be too challenging if you’re recovering from a heart problem or are at risk for a cardiac event. Push-ups and pull-ups can be quite challenging, even for someone with no health problems. However, some bodyweight exercises can be helpful. For example, the Heart Foundation recommends bodyweight lunges for people recovering from a heart attack. Resistance exercises such as lunges help build up your muscle mass and strength.

To do a lunge, stand with both feet together. Step back with one foot and bend your back knee so that it drops down towards the ground. Then, step up so that your feet are together again, and repeat on the other side. The Heart Foundation recommends starting with 10 repetitions, then increasing gradually to 20 repetitions. You can also add some resistance to the lunges by holding cans of food in your hands or bags of rice.

Avoid: Distance running

Woman running along road

Running at a moderate pace can be healthy, but intense training is not for people with heart problems

The Cleveland Clinic says that you can tell if your workout is moderate if you can keep speaking throughout. Running becomes problematic when the distance is too great or the speed is too intense. The article mentions that some athletes are so extreme, they race in events that go up to 50 miles. Even if you’re not that intense, you should remember to keep your runs at a moderate intensity. Don’t overdo it until your doctor says you can.

A small percentage of people who do long, strenuous runs can develop heart problems over time. For example, the walls of your heart can thicken and the heart can have scarring. High-intensity cardio can cause changes in the heart rhythm, which can also be dangerous for people with heart problems. It’s best to keep your workouts at a moderate intensity.

Do: Jogging

Couple jogging on beach

Unlike distance running, which can be too intense for someone with a heart problem, jogging can be helpful.

Typically, jogging refers to a lower speed or lower intensity of running. Cardiologist Dr. Tamanna Singh recommends moderate-intensity exercise such as jogging, even if there are some potential risks (via the Cleveland Clinic). That’s because the risk that comes from exercise is less than the risk from not exercising.

Physical activity is an important part of recovering from a cardiac event and creating a healthy lifestyle. Aerobic exercises such as jogging and swimming can be part of a healthy routine. In fact, the American Heart Association recommends that most people should get 150 minutes of moderate-intensity aerobic exercise per week. That equals a little over 20 minutes per day. Some of the benefits listed by the Cleveland Clinic include lower blood pressure, better sleep, and improved memory. There’s also a link to reduced risk of dementia and depression.

Avoid: Single rep max weightlifting

Man preparing to lift heavy barbell

To figure out how much weight you can lift, you can do a test of one rep with as much weight as possible. For example, you can load up a barbell with heavy weight and do a bench press, incrementing the weight until you can barely complete a rep, to find out how much weight you can do. Some sports, such as powerlifting and Olympic weightlifting, test the one rep maximum strength of athletes.

If you have heart problems, it’s best to avoid doing such an intense activity. A study published in the European Journal of Preventative Cardiology attempted to improve guidelines for rehabilitating people with cardiac issues. For weight training, they recommend doing a strength test with multiple repetitions, rather than just one, to see how strong a patient is. They explain that abdominal straining occurs in one repetition maximum exercises, as does an increase in blood pressure, both of which can be dangerous.

Do: Hamstring curl

Woman standing and holding foot

Getting stronger is important if you have a heart problem, and it’s important to work multiple muscle groups to strengthen your overall body. Working your legs is important, since you use them in activities like walking and lifting objects. The American Heart Association has a list of strength and balance exercises that are helpful for cardiac rehab.

One such exercise is a hamstring curl, which works the muscle that runs down the back of your thigh. It also stretches the quadriceps, the muscle that runs down the front of your thigh. To do the hamstring curl, stand behind a chair with both hands on the back of the chair. Shift your weight onto one leg, then lift the other leg up by bending at the knee. Continue to raise your foot in the air until it’s about 12 inches off the ground, then return to the start. Repeat 6 to 8 times, then switch legs. You can wear ankle weights to make it harder.

Avoid: Strenuous daily activities

Woman shoveling snow during winter

There are some movements you can do in daily life that cause a lot of strain on the body, but might not seem that way since they don’t mimic weight training exercises. If you’re recovering from a cardiac event like a heart attack, you should be careful to avoid these exercises. An article from Chest Heart and Stroke Scotland lists a few things you should avoid.

Pushing a heavy wheelbarrow is one activity you should refrain from doing, since it causes a lot of strain on the muscles and can tax the heart. Pushing a car is another no-no, because it causes tremendous strain. A similar exercise that you should avoid in the gym is a sled push, which involves pushing heavy weight. Yet another movement you shouldn’t even attempt to pull off is shoveling snow. The quick, strenuous movements involved in the activity can be bad for your heart. Moreover, snow can weigh a significant amount, so avoid shoveling until you’re strong enough to handle it comfortably.

Do: Arm raises

Man performing lateral shoulder raise

There are many ways to gently progress through a resistance training program. A simple solution for people with heart problems who want to start lifting weights is to do seated exercises. This takes away the balance component that many standing exercises require and makes weight training more accessible. A seated exercise that the American Heart Association recommends is the arm raise.

To start this shoulder-strengthening exercise, grab a pair of one- to two-pound dumbbells. Sit in a chair with proper posture and both feet planted flat on the ground. Your arms should be by your sides and palms facing each other. Breathe in, then slowly exhale and lift your arms straight out to the sides until your arms are parallel to the ground. Hold at the top for a second, then lower the weights until your arms are by your sides again. Perform 6 to 8 reps, rest, then perform another set.

When to avoid all vigorous exercise

Doctor consulting with patient

In most cases, exercise is healthy and beneficial for someone with heart problems. However, some issues are serious enough that you should avoid any vigorous exercise, at least for the time being.

In general, there’s a significant difference between moderate-intensity exercise and a vigorous workout. A paper published in Circulation explains that compared with sedentary activity, a vigorous workout increases the risk of cardiac death by 16.9 times. The risk of a heart attack during a vigorous workout is 2 to 10 times higher than sedentary activity.

Some of the conditions mentioned in the paper that increase the risk from exercise are heart failure, severe aortic stenosis, uncontrolled arrhythmia, and acute coronary syndromes. People with acute coronary syndromes shouldn’t do any vigorous exercise until they’ve had no symptoms for at least a week and have been undergoing stable medical therapy. Doctors can avoid the risks of exercise in their patients by screening them properly before making recommendations, counseling their patients, and creating a gradually progressive exercise program.