NEW YORK (Reuters Health) – For many people with heart failure, gone are the days when doctors advised them to rest and avoid physical activity.

In guidelines announced this week, the American Heart Association (news – web sites) recommends exercise for people with heart failure, even those who are waiting for a heart transplant.

Some people with heart failure, including those with unusual heart rhythms, may need to be monitored during exercise, according to the report. Others may be able to exercise safely at home after they have undergone a supervised training program.

“It seems counterintuitive, but walking, biking, swimming, dancing–all kinds of aerobic exercises–can help improve the patient’s sense of well-being,” Dr. Ileana L. Piña, who headed the AHA committee that wrote the recommendations, said in a statement. Piña is at Case Western Reserve University in Cleveland, Ohio.

Exercise may provide several benefits to people with heart failure, including improvements in blood-vessel function, exercise capacity and quality of life, according to the report in the March 4th issue of Circulation: Journal of the American Heart Association. Exercise may also improve the flow of oxygen to muscles and lower levels of hormones that can contribute to heart failure symptoms.

The recommendations focus on aerobic activities, such as riding a stationary bike or walking on a treadmill, but resistance training, such as lifting light weights, may improve muscle strength in people with heart failure, according to the report. The AHA experts caution, however, that the safety of resistance training in people with heart failure needs to be confirmed in larger studies.

The AHA recommends an individualized approach to exercise. People with heart failure should take it easy at first and slowly increase their exercise as they become stronger.

Although exercise plans will vary from person to person, the AHA recommends warming up and cooling down before and after exercising.

“We know that a rapid sudden surge of adrenaline is not good for anybody,” Piña told Reuters Health. “When people stop exercising, the adrenaline goes up initially and that could leave a patient vulnerable to (abnormal heart rhythms).”

Exercising 20 to 30 minutes three to five times per week is a good goal, although people who become exhausted after exercise may need to rest a day between sessions, according to the report.

In heart failure, the heart becomes enlarged and loses its ability to pump blood efficiently. Symptoms include breathlessness, fatigue and swelling of the feet due to fluid accumulation.

According to the AHA, nearly 5 million people in the US have heart failure.

SOURCE: Circulation 2003;107:1210-1225.