Many physicians recommend exercise to heart patients and to people in general to reduce the risk of cardiovascular disease and other disorders. There are many types of exercise that can promote heart health, including: walking, aerobic exercise, yoga, Tai Chi, weight lifting and resistance training, kick-boxing, swimming, and others. The basic rule of thumb for all of these activities is to start slowly and work up to a comfortable level of heart-healthy exercise.

It is important to get a physician’s approval before starting an exercise program and to follow the physician’s recommendations or precautions on the types and level of exercise. Some people with heart disease, such as heart attack patients, have strict limits on the kind and amount of activity they can do.

Popular exercises and tips for their use include:

• Walking. The AARP, an advocacy organization for people over the age of 50, endorses walking as an aerobic activity fit for all. People of any age and in virtually any physical condition can engage in some sort of walking program. Experts suggest beginning by walking three times a week at a comfortable distance and speed. For some people, this may be a mile, and for others it is to the mailbox.
  
  The goal is to increase activity without causing muscle cramping or injury. Over time, people can gradually increase their walking speed, distance and number of walking sessions a week.
  
  People are urged to choose carefully where they are going to walk. The risk of injury is reduced when walking on flat, even ground with little or no traffic, such as in a mall. There is also less risk of being involved in a crime when walking in public, well-lit areas. 
  
  For people who choose to carry weights while walking, the following guidelines are offered:
  
  
• • Carry equal weights in each hand or around each wrist.
    
    
  • Do not strap weights to the ankles or lower legs, because of increased risk of a knee injury.
    
    
  • Do not swing the arms too far while walking; keep the swing natural to reduce the risk of a back injury.

Some people choose to walk with a dog, which tends to make the walk more enjoyable for the pet and the owner. However, all pet owners need to take the dog’s comfort into consideration when heading out on particularly hot or especially cold day. Finally, neither humans nor animals should dash off on a fast walk right after eating a heavy meal.

• Aerobic exercise. Aerobic exercises are those that increase the heart rate for a sustained period of time, as opposed to resistance exercises that rely on short bursts of strength. Aerobic exercises include walking, biking and swimming. Water aerobics are an excellent, low-impact exercise for people who cannot withstand the pounding involved with running or stress associated with biking. Like all forms of exercise, aerobics should be started gradually. People who are interested in aerobics should not sign up for advanced spinning classes or step classes unless they are already fit. Spinning is a form of intense exercise on a stationary bicycle, usually situated in an aerobics studio, and step classes are a form of aerobics that use small platforms.
  
  
• Yoga, Tai Chi and Pilates. Yoga and Tai Chi are Eastern forms of movement that improve strength and flexibility. The U.S. National Institutes of Health (NIH) suggests trying yoga or Tai Chi to reduce the risk of heart disease. Pilates has also become popular for improving core strength and flexibility.
  
  Yoga and Pilates may involve some stretches and positions that are inadvisable for some heart patients or patients with back problems. Therefore, patients are encouraged to speak to their physician before beginning.
  
  Tai Chi is a gentle form of exercise that people in China tend to use well into old age. It may be a good place to start for people who have not been exercising. It is advisable to take classes from instructors who are trained or certified in the specific form of exercise.
  
  
• Weight lifting. Studies have shown that resistance training, with either free weights such as dumb bells or resistance machines, has numerous benefits. Weight training benefits people well into old age by increasing strength and bone health, thus reducing the risk of falling accidents and helping people retain balance and mobility. However, weight training carries risks. Inexperienced people frequently start out "too heavy," which can result in training injuries or in such painful recovery that they may stop exercise altogether. If it's economically feasible, hiring a personal trainer (available through most gyms) for a few sessions can help a person learn to lift weights properly. This will include teaching the weight lifter how to use each machine, the proper motions for maximum benefit, and the right form to reduce the risk of a training injury. Many people also find it helpful to weight train with a partner, who can act as a spotter and a motivator.
  
  
• Kick-boxing. One popular trend in exercise is kick-boxing. For many, it is a high-energy and enjoyable activity. However, people can easily sustain injuries from this form of exercise. The following tips are offered to prevent problems:
  
  
• • Always start with a qualified instructor.
    
    
  • Do not do too much too soon. Throwing oneself completely into complicated kicks and punches in the first kickboxing class, especially without one-to-one supervision, increases the risk of injury.
    
    
  • If uncertain that a move about to be performed is correct, reconsider and check out the move with the instructor.
    
    
  • Consider beginning with other forms of martial arts training (e.g., karate), which progressively build muscle groups before starting kickboxing moves. 
    
    
• Joining a health club. Many health clubs are thriving businesses that might not take the time to ask individual members about their heart or medical history. It is important for all heart patients to ask questions such as:
  
  
• • Will there be a staff member here at all times who has current certification in cardiopulmonary resuscitation (CPR)?
    
    
  • Does the facility have a defibrillator in case of emergency?
    
    
  • Will there be a staff member here at all times who is trained to use the defibrillator?
    
    
  • Where is the closest hospital emergency room, and what transportation services are available for getting there?
    
    
  • Are there specific classes geared toward older individuals who are at higher risk for medical problems?
    
    
  • Do you have personal trainers on staff who can help teach me how to use the equipment? What are their rates?
    
    

Although the benefits of exercise far outweigh the risks, it is important to be in a facility that is prepared for any emergency that might arise.