If you've had a heart attack, you never want to experience another.
But even if your brain — and your doctor — tells you the best way to avoid one is to exercise regularly, sometimes that's hard to do. Especially if you're worried about every odd sensation, wondering whether vigorous exercise could trigger the very thing you're trying to prevent.
Two Austin athletes — javelin thrower Tom Dalke, 44, and triathlete Jim Hinkel, 60, former co-workers who had heart attacks a week apart in 2008 — know all about those concerns. They've overcome them, and returned to competition without skipping a beat.
Dalke, a mechanical engineer, woke up one March morning sweating and with achy arms. On his way to church, he made it as far as the garage before he collapsed. "I felt like all the air was sucked out of my body," he says.
A week later, Hinkel had a heart attack while pedaling up a long hill during a 70-mile training ride for an upcoming triathlon. "It was a shock. I thought I was in such good shape," says Hinkel, who now works as a financial analyst.
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So much for being the healthiest-looking guys in the company.
Most cardiologists advise patients to start an exercise program after a heart attack. Exercise helps improve heart muscle function and keeps off excess weight.
Mishel Dziadziola, a cardiac rehab nurse at Heart Hospital, notes that American College of Cardiology research shows that many patients who go through cardiac rehab have almost no signs of their attack if they stick to exercise and a healthy diet long-term. "After three years, it's like they never had a heart attack before," she says.
Patients should check with their physicians before starting an exercise program.
Dziadziola recommends that patients rest and avoid lifting anything for at least a week after being released from the hospital. After a week or two, it's usually OK to start walking. Within a month, it's time for a cardiac rehabilitation program, where staffers use heart monitors to oversee patients as they start exercising more vigorously.
Most patients stay in rehab — exercising with heart monitors for an hour at a time, three days a week — for about 12 weeks. Then it's home, where Dziadziola advises exercising 45 to 50 minutes at a time, six days a week. "Just walking 45 minutes a day has a lot of benefits," she says.
She also educates patients about signs of heart attacks, such as chest pain, dizziness, lightheadedness, shortness of breath, nausea, indigestion, numbness in the arms or jaws or, for women, back pain. "Obviously there's going to be shortness of breath when exercising, but when you begin you should be able to talk but not sing," she says.
Exercising under supervision at cardiac rehab can help ease anxiety and reassure patients that they're not having another attack, says Dr. Scott Elkin, an Austin psychiatrist. Elkin, an athlete and personal trainer himself, recently underwent surgery to repair a defective valve in his heart.
It also helps to talk with others who have had similar experiences or join a support group, he says.
On the surface, neither Dalke nor Hinkel seemed like obvious candidates for a heart attack.
A longtime tennis player, Hinkel had about 10 marathons and many triathlons under his belt, but his father and grandfather had both had heart attacks. Doctors put in three stents to open Hinkel's veins. He started walking a week after he was released from the hospital and then added cycling a week later.
Getting back to exercising, he says, was sort of like riding a bike for the first time after not doing it for decades. He couldn't release his death grip on the figurative handlebars.
"You keep thinking, ‘Is it going to happen again? Is this normal?' " he says. "I remember having chest pains while cycling and thinking, ‘Now you've done it,' wondering if I had pushed too hard and triggered another attack."
Eventually, those worries faded.
He had to resign himself to just being a participant instead of a top finisher in his age group for a while, but since his heart attack he has finished two Ironman half-triathlons and has become an avid mountain biker. He's also switched to a vegetarian diet, gets annual checkups and advocates for others to get stress tests, even if they think they're fit.
Dalke, a weightlifter, could bench press 425 pounds before his heart attack. But he ate steak three times a day and didn't do much cardiovascular exercise. Heart attacks also ran in his family.
"Before, I thought I was fit, but I really wasn't," he says. "I was strong and big, but I wasn't healthy."
He'd also torn a chest muscle lifting weights before his heart attack, and it still hurts sometimes. That sparks worries.
"Any time now that I get any numbness or odd feeling, I think ‘Oh no, a heart attack,' " he says. "I can never tell if it's my heart or my chest muscle."
Today he makes cardiovascular exercise a regular part of his program. He still lifts, but he doesn't go heavy. Steak is only an occasional treat.
A former high school track athlete, he's also throwing javelin again. He won a national championship in his age group last year and came in fourth at world competition this year. He's setting his sights on the World Masters Championships in Brazil in 2013.
The heart attacks are behind both men. They've rededicated themselves to fitness and more competition lies ahead.
Tips on resuming exercise after a heart attack
Talk with your cardiologist before starting an exercise program.
Take a supervised cardiac rehabilitation program.
Talk with other people who have a heart attack so you know what to expect.
Join a support group like Mended Hearts at the Heart Hospital of Austin.
Balance exercise with rest.
Monitor your heart rate during exercise.